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.