CURRENT APPROACHES TO CORRECTING HEMOSTASIS IN UTERINE CANCER SURGERY

Abstract

Actuality. Modern research shows that activation of coagulation is not only a risk factor for thrombohemorrhage syndrome, but can be an indicator of tumor aggressiveness and poor prognosis for patients with cervical cancer. The aim of the study was to reduce perioperative blood loss in patients with cervical cancer. Materials and methods. There are examined the results of surgical treatment of 92 patients with a diagnosis of cervical cancer. Research was conducted at the Department of Gynecology and Intensive Therapy of the Odessa Regional Hospital in 2008–2015. The average age of patients was (53.31±5.65) years. Blood clotting system was investigated using low-frequency pyezoelectric thromboelastography. Patients were divided into two groups depending on the type of hemocoagulation disorders correction. 44 patients of 1 group received in complex correction epidural anesthesia at the level of L2–L3 7–12 ml of 0.5% bupivacaine and 10 mL of 0.5% bupivacaine in the first postoperative day fractionally. Anticoagulant therapy was bemiparin 2500 IU in the first post-operative day and for 7 days after. Antifibrinolytic therapy in these patients has not been evaluated. 48 patients of second group had complex correction which included epidural anesthesia at the level of L2–L3 7–12 ml of 0.5% bupivacaine and 10 mL of 0.5% bupivacaine in the first postoperative day fractionally. Anticoagulant therapy was bemiparin 2500 IU in the first post-operative day and for 7 days after. Patients in this group was assigned tranexamic acid for 30 min prior to surgery in a dose of 20 mg/kg, and followed infusion — 5 mg/kg per hour for the first postoperative day. 48 patients of 1 group received in complex correction epidural anesthesia at the level of L2–L3 7–12 ml of 0.5% bupivacaine and 10 mL of 0.5 % bupivacaine in the first postoperative day fractionally. Statistical analysis was provided using the methods of parametric and nonparametric analysis (software Statistica 6.0 (StatSoft Inc., USA). Results. In the preoperative period in patients with cervical cancer there was found activation of fibrinolysis, increasing of platelet aggregation and hypercoagulability. Patients with cervical cancer had structural and chronometric activation of vascular-platelet hemostasis with an increased generation of thrombin and the activation of the fibrinolytic activity of the blood. The studies proved that the use of antifibrinolytic therapy helped to reduce perioperative blood loss by 29%. Conclusions. Patients with cervical cancer had changes of the hemostatic system in comparison with the norm state before treatment: hyperaggregation, hypercoagulation and activation of fibrinolysis. Use of epidural anesthesia, tranexamic acid and bemiparin is the most appropriate to reduce blood loss and recovery of the hemostatic system capabilities.