| Obstructive jaundice patients have abnormal blood clotting mechanism perioperative, and early stage performance for high blood coagulation state, but the exact coagulant, anticoagulant and fibrinolytic function change is unclear after pancreaticoduodenectomy. Perioperative bleeding and thrombosis in patients with the clinical observation, prevention and treatment of complications lack of pertinence; the bleeding is low occur after pancreaticoduodenectomy for obstructive jaundice patients, but bleeding mortality is higher. Whether preoperative bilirubin level relations with bleeding, it is a problem urgently to be solved in clinical. We retrospectively analyzed of obstructive jaundice patients perioperative blood coagulation mechanism and coagulation function change with the relationship between the bleeding complications, to guide clinical treatment.Objective:The purpose of this topic is to explore the relationship between the variation of blood coagulation mechanism and coagulation changes with the complications of obstructive jaundice underwent pancreaticoduodenectomy.Methods:We retrospectively analyzed of63cases of patients clinical data undergoing PD. These patients were divided into three groups according to the serum total bilirubin level. These were not jaundice in the patients in group A and the TBIL<17.1umol/L. In group B, the patients had jaundice and the TIBL<171umol/L. In group C, the patients had jaundice and TIB≥171umol/L. The general condition and, in the morning of preoperative and postoperative7d and14d, extraction whole blood for routine blood coagulation and thromboelastography (TEG), observing the change of coagulant function of patients with obstructive jaundice in perioperative, and the relationship between the change of blood coagulation and complications. Research plan was approved by the ethics committee at our hospital, all patients or families are informed consent. Exclusion criteria:(1) the existence of congenital coagulation dysfunction;(2) the history of chronic liver disease;(3) take anticoagulant drugs a long time before the patient is sick;(4) severe patients with organ dysfunction. Surgical procedures63cases of patients implement conventional pancreaticoduodeectomy(child reconstruction), the pancreatic anastomosis way according to the situation of pancreatic stump texture, degree of thickness of the pancreatic duct and performer experience, including pancreatic duct with jejunum mucosa to mucosa anastomosis, pancreatic duct supporting tube is placed in vitro derivation59cases, set into the pancreatic anastomosis end sides4cases; Cholangioenterostomy is placed within T tube drainage and leads to body; Routinely placed double-tube drainage in bilioenteric anastomosis. Intraoperative jejunuostomy underwent to facilitate early postoperative enteral nutrition. Observation indexes Enrolled patients in preoperative1day, after7day and14day early morning on an empty stomach was collected venous blood to detect routine blood coagulation indexes and thrombelastogram (TEG). Blood is immediately inspection, so as to remove interference factors. Conventional coagulation test use Japan SYSMEX CA-7000fully automatic Thrombosis/Hemostasis Analyzer, including prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR) and fiber fibrinogen (FIB); Platelet (Pit) was measured by SYSMEX Japanese Company SYSMEX HST302blood pipeline. Using Haemoscope5000series Thromboelastogram and Haemoscope Company provided Kaolin accelerator. Measurement indicators:reaction time (R-value), normal range is5to10min, reflect the role of clotting factors, the higher the R value, the lower activity of clotting factor, clotting time (K-value) K value is formed for the end point of the R-value and amplitude of the time used up to20mm, the normal range of1to3min; blood formation rate (Angle value) from a blood clot to form points to trace the biggest tangent Angle with the horizontal curve radian, normal range of53to72; K value and Angle value reflects the fibrinogen level and part of the function of platelet; maximum response amplitude (MA value) reflect the the maximum intensity of the clot, and depends primarily on the quality and quantity of the platelet, normal the range of50to70mm. While collecting patients’age, gender, total bilirubin, blood transfusions, operative time, intraoperative blood loss, hospital stay, and general information.Results:63patients with conventional coagulation and TEG index Conventional coagulation indexFIB is more in jaundice patients than no jaundice after pancreaticoduodennctomy; FIB difference was statistically significant(P<0.05), the rest of the APTT, PT, INR, Pit and postoperative FIB difference was no statistically significant. For obstructive jaundice patients before and after surgery, fourteenth day postoperative PT value and INR difference were statistically significant in group B(P<0.05), seventh day postoperative PT value difference were statistically significant in group C(P<0.05), the remaining differences were not statistical significant. TEG indexJaundice patients in group B and C the R, K values are gradually decreasing trend, Angle, MA values are gradually increasing trend. All patients perioperative the K, Angle, MA value was not statistically significant(P->0.05). For jaundice patients before and after surgery, postoperative seventh day R, K, Angle value the difference was statistically significant in group B(P<0.05). Postoperative seventh day R, K, value the difference was statistically significant(P<0.05); postoperative fourteenth day R value the difference was statistically significant in group C(P<0.05).63patients with general information and perioperative complicationsJaundice is more severe, the bile duct diameter, intraoperative bleeding and postoperative hospital stay between groups difference was statistically significant (P<0.05).28cases of a total63patients with postoperative complications, the complication rate was44.4%, and2patients died, which are gastrointestinal anastomotic bleeding; the mortality rate was3.2%. Incidence of postoperative gastrointestinal bleeding group C compared with group A difference was statistically significant (P=0.048). With the bilirubin level increased, the incidence of postoperative bleeding has gradually increased.Conclusions:The thromboelastography detection more sensitivly than conventional coagulation test. Preoperative patients with obstructive jaundice exist in coagulopathy that performance fibrinogen and platelet dysfunction, postoperative coagulation performance that the clotting factors increases, increased fibrinogen and platelet function enhancement. Preoperative severe jaundice increased intraoperative and postoperative bleeding incidence and the hospital stay. |
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