| Surgerying for malignancy obstructive jaundice patients is still associated with significant morbidity and mortality. Haemorrhage is the second complication among these patients in the perioperative period. In order to determine the high risk factors responsible for haemorrhage following operation for these patients, we conducts this present analysis. We still investigate the coagulation and fibrinolysis disorders of these patients in the perioperative period.Method and Results: We studied 269 patients with malignancy obstructive jaundice experienced operation, among whom 20 haemorrhage happened. According to the SAS stepwise regression analysis we find that radical operation, suffering from severe accompanied diseases (such as hypertension, diabetes, coronary heart diseases and ulcers) previously, sexual (men), albumin<30g/L and thrombocytopenia before operation, which are all risk factors for haemorrhage after operation. There are three kinds of haemorrhage sites in these patients. Erosive bleeding caused by anastomose fistula is the commonest one. Operative fields haemorrhage often result in secondary disseminated intravascular coagulation, which is the second bleeding site. Gastrointestinal ulcer is also commonly among them, which is often caused by stressing, acid stomach, bile salt upstream into stomach. Prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(Fig), antithrombin III antigen(AT-III:Ag), fibrin/fibrinogen degradation products(FDP), D-dimer(D-D),α-granule membrane protein(GMP-140) and von Willebrand factor antigen(vWF:Ag) were measured by ELSIA or immune colorimetry in 20 patients with malignancy obstructive jaundice and 10 healthy individuals. Blood samples of patients in the experiment group were measured before operation, 1 day, 7 days and 14 days after operation. The results shows that there was significant difference in Fig, AT-III:Ag, FDP, D-D and vWF:Ag between the two groups. They all increased more significantly than in the controls and usually reached the highest in the 7days after operation. One week after the operation is the most risk periodoccurring coagulation disorders that can't return to normal until 2 weeks after operation. We also examine all whole blood samples with Sonoclot Analyzer (SNC; Sienco, Wheat Ridge, CO), which provides a viscoelastic evaluation of the entire coagulation cascade, including platelet interaction and fibrinolysis. It shows that act onset and time to peak are all shorten than that of the controls, clot rate and platelet function are all increased than that of the controls. Compared with haematological results we also find a significant correlation between act onset and APTT, clot rate and Fig, platelet function and its quantity.Conclusion:We should optimize preoperative preparation of the patient, including controlling the severe accompanied diseases and increasing albumin above 30g/L. We should pay meticulous attention to details during the operation and give continuous close observation for the patients in the post operative period so as to detect thromboembolic or bleeding complications in time.Paying attention to control anastomotic denhiscence after operation can decrease anastomotic bleeding. Supplying coagulation factors when it needs and applying heparin restraining hypercoagulation and fibrinolysis are the main measures to reduce the haemorrhage and thrombembolic complications in the preoperative period.There is an increased incidence of thromboembolic before operation and obscure disseminated intravascular coagulation or bleeding tendency in the early stage after operation and get a hypercoagulation and fibrinolytic state on seven days after operation, which don't return to normal until two weeks. Sonoclot Analyzer is reliable, fast, easy-handle, inexpensive and can be used bed-side. It shows that Sonoclot Analyzer is a useful avaible technique for monitoring perioperative coagulation disorders in patients with malignancy obstructive jaundice.
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