目的    探讨胰十二指肠切除术后围手术期凝血功能变化及黄疸与并发症的关系。 方法    回顾性分析2011年2月至2012年8月南京军区南京总医院普外科5区行胰十二指肠切除术63例病人的临床资料。根据有无黄疸及黄疸的严重程度将病人分为3组，无黄疸者为A组，总胆红素（TIBL）≤17.1 μmol/L；黄疸病人中TIBL＜171.0 μmol/L为B组，TIBL≥171.0 μmol/L为C组。术前及术后7 d、14 d空腹抽取全血进行常规凝血和血栓弹力图（TEG）检测，比较病人围手术期凝血功能的变化及与术后并发症的关系。 结果    随着胆红素水平增高，各组间术中出血量差异有统计学意义（P<0.05）；术后胃肠道出血C组高于A组，差异有统计学意义（P<0.05）；术后住院时间C组高于B组和A组，差异有统计学意义（P<0.05）。检测凝血功能发现，术前3组病人纤维蛋白原差异有统计学意义（P<0.05）；术后A组纤维蛋白原（FIB）、B组凝血酶原时间（PT）和国际标准比值（INR）、C组PT较术前差异统计学意义（P<0.05）。但血栓弹力图检测提示黄疸病人两组中反应时间（R）、凝血形成时间（K）值有逐渐减小趋势，血形成速率（Angle）、最大反应幅度（MA）值逐渐增大，各组记录数值与术前比较均有改变。 结论    梗阻性黄疸病人术前凝血功能紊乱主要表现为纤维蛋白原及血小板功能障碍，术后主要表现为凝血因子增多、纤维蛋白原增加和血小板功能增强。术前重度黄疸病人术中、术后出血发生率及住院时间增加。

Coagulation function changes and its relationship with complications after pancreaticoduodenectomy：An analysis of 63 cases        LI Liang, WANG Xin-bo, WANG Si-zhen, et al. Research Institute of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA, Medical College of Nanjing University, Nanjing 210002, China
Corresponding author：WANG Xin-bo, E-mail:wxinbo@hotmail.com
Abstract    Objective    To investigate the change of blood coagulation fuction and the relationship between jaundice and complications on pancreaticoduodenectomy(PD). Methods    The clinical data of 63 patients who received PD at the Nanjing General Hospital of Nanjing Military Command PLA from February 2011 to August 2012 were retrospectively analyzed. 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 TIBL≤17.1 μmol/L. In group B, the patients had jaundice and the TIBL<171 μmol/L. In group C, the patients had jaundice and TIBL≥171 μmol/L. In the morning of preoperative and postoperative 7 d and 14 d, extraction whole blood for routine blood coagulation and thromboelastography (TEG) were performed to observe the change of coagulant function of patients with obstructive jaundice during perioperative period, and the relationship between the change of blood coagulation and complications. Results    With the increased level of bilirubin, blood loss in the differences groups was statistically significant (P<0.05). The incidence of postoperative gastrointestinal bleeding in group C was higher than that in group A, and the difference was statistically significant (P<0.05). Postoperative hospital stay in group C was higher than that in group B and group A, the difference was statistically significant (P<0.05). Routine coagulation test results found that preoperative fibrinogen of three groups have significant difference (P<0.05). Postoperative FIB of group A, PT and INR of group B, PT of group C compared with preoperative ones have obvious difference (P < 0.05). But thromboelastography detecting suggested R, K value had decreased gradually in both groups and Angle, MA value had increased gradually. Each record compared with the preoperative values had changed. Conclusion    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 enhancements. The incidence of intraoperative and postoperative bleeding and the hospital stay were increased in patients with preoperative severe jaundice.