부산대학교 도서관

Objectives: The true incidence of pulmonary embolism (PE) in patients undergoing laparoscopic surgery for gynecologic malignancies is unknown. The aims of this study were to determine the incidence of PE in laparoscopically-treated cancer patients, to compare the results with those treated with open surgery, and to investigate the efficacy of low-dose unfractionated heparin (LDUH) to prevent the occurrence of PE.Methods: Thirty-three patients with gynecologic malignancies were laparoscopically-treated (laparoscopy group [LS] ) . The procedures included paraaortic-pelvic lymphadenectomy in all surgeries, along with hysterectomy, salpingo-oophorectomy, omentectomy, and/or appendectomy, depending on the cases. In all patients, elastic stockings (ES) and intermittent pneumatic compression (IPC) were used for postoperative thrombosis prophylaxis. In the latter half of the study period, LDUH was added to ES + IPC. Within 10 days postoperatively, lung perfusion scintigraphy was performed for the detection of PE, irrespective of clinical symptoms. The results were compared with those obtained from 20 control patients treated with traditional open surgery (laparotomy group [LT] ) .Results: Pulmonary embolism developed in 5 cases (15.1%) in the LS group and in 3 cases (15.0%) in the LT group. Of 8 cases with PE, only 1 case presented a clinical symptom, but the other 7 cases showed abnormal findings only in lung perfusion scintigraphy. The addition of LDUH resulted in a smaller number of PE detected in both the LS (from 4/14 [28.6%] to 1/19 [5.7%] ) and LT groups (from 2/10 [20%] to 1/10 [10%] ), but the differences were not statistically significant.Conclusion: The incidence of PE after laparoscopic and open surgery for gynecologic cancer was not different. Appropriate preventive measures against PE should be taken, even in laparoscopic surgery of gynecologic malignancies, as the incidence of PE is high and can be lethal.