Effect Of Obstructive Jaundice On Perioperative Coagulation Function And Complications During Pancreatoduodenectomy

Objective: To investigate the influence of preoperative bilirubin level on coagulation function and related complications in patients with obstructive jaundice during perioperative period.Methods: To collect clinical data of 126 patients pancreatoduodenectomy(PD)from the Second Department of General Surgery,the First Hospital of Lanzhou University from Jul.2015 to Jul.2017.The patients were divided into three groups based on plasma TBIL levels: Group A:mild jaundice group(preoperative TBIL<171?mol/L);Group B: moderate jaundice group(171?TBIL<342?mol/L);Group C: severe jaundice group(TBIL?342?mol/L).Detailed records:(1)Basic indicators of patients: age,gender,preoperative TBIL,postoperative 1d TBIL,postoperative 7d TBIL,CA199,ALb,AST,ALT,operation time,intraoperative blood loss,intraoperative blood transfusion,hospitalization costs,hospital stay;(2)Perioperative indicators of PD: FIB,PD,PT,INR,APTT,PLT,R value,K value,? angle,and MA value of each group of patients before and after PD;(3)Postoperative indicators of patients: bleeding,pancreatic fistula,bile leakage,abdominal infection,delayed gastric emptying,surgical incision infection.The above data were organized and analyzed by using statistical methods.The effects of preoperative jaundice on coagulation function and related complications were studyed in perioperative period of PD.Results:(1)Coagulation function and TEG indicators of each group before PD: FIB was(267.8±64.1)mg/dL,(350.4±69.1)mg/dL and(380.9±63.9)mg/dL in group A,B,C respectively,which show a gradual increase trend from A to C;The ? angle in C group(59.7±10.4)°was significantly higher than that of A group(54.2±6.2)°,the FIB and ? angles were statistically different among groups(P<0.05).(2)Coagulation function and TEG indicator within each group: Group A: FIB was(267.8±64.1)mg/dL,(395.2±78.7)mg/d L,(442.3±60.3)mg/dL,in preoperative,postoperative 1d and 7d respectively,showed a gradually increasing trend,there was a significant difference in different stages(P<0.05);Group B: FIB was(350.4±69.1)mg/dL,(412.5±99.2)mg/dL,(430.4±68.4)mg/d L in preoperative,postoperative 1d and 7d respectively,showed a gradually increasing trend.R value in postoperative 7d is significant decreased than in preoperative(7.4±0.9 vs 8.3±2.4)min(P<0.05).K value in postoperative 7d is significant decreased than in preoperative(1.9±0.7 vs 2.6±1.3)min(P<0.05).?angle in postoperative 1d is significant increased than in preoperative(60.3±5.8 vs 56.8±9.6)°(P<0.05).MA value in postoperative 7d is significant increased than in preoperative(67.1±4.4 vs61.8±5.9)mm(P<0.05).Group C: FIB was(380.9±63.9)mg/dL,(415.7±81.1)mg/dL,(446.0±83.8)mg/d L in preoperative,postoperative 1d and 7d respectively,showed a gradually increasing trend.R value in postoperative 7d is significant decreased than in preoperative(7.2±0.9 vs 8.4±2.3)min(P<0.05).K value in postoperative 7d and 1d is significant decreased than in preoperative(2.0±0.7,2.0±0.6 vs 3.1±1.1)min(P<0.05).MA value in postoperative 7d and 1d is significant increased than in preoperative(67.9±4.2,64.6±5.9 vs61.7±5.5)mm(P<0.05).(3)With the preoperative TBIL levels increased,the AST,ALT,intraoperative blood loss,postoperative hospital stay,and hospitalization costs were statistically different among groups(P<0.05).Age,gender,Alb,operative time and intraoperative blood transfusion were no significant difference in the three groups(P>0.05).The complications occurred in 38 cases in this study.The incidence was 30.2%(38/126).With the increase of preoperative TBIL levels,the incidence of postoperative complications increased gradually,but no significant difference exists(P>0.05).Conclusion:(1)With the gradually increase of TBIL levels in each groups,FIB,coagulation factors,and PLT gradually increased,and the coagulation function disorders;(2)With the gradual decrease of TBIL levels after surgery,the coagulation factor content gradually decreased,coagulation function gradually recovered;(3)With the increase of TBIL levels,intraoperative blood loss,postoperative pancreatic fistula,postoperative biliary fistula,postoperative bleeding and other complications have gradually increased.