Blood Coagulatory Disturbance in Perioperative with Obstructive Jaundice

Akira Usuba, Ryoichi Motoki, Mitsunori Takahara, Kazuhito Matayoshi, Zenjiro Watanabe, Toshiyuki Takeshige, Akio Ohishi, Junichi Miura, Yukio Endoh, Hitoshi Inoue

First Department of Surgery, Fukushima Medical Collge

To determine the relationship between blood coagulatory disturbance and obstructivejaundice, we studied the hypercoagulable state in 12 patients with obstructive jaundice due to pancreas head cancer, common bile duct cancer or chronic pancreatitis who had undergone radical resection after choledochal drainage. Before the choledochal drainage, the hypercoagulability was higher in patients with more than 20 mg of total bilirubin (TB) per dl than in patients with less than 20 mg/dl. After the choledochal drainage, the hypercoagulabe state disappeared, while a low level of antithrombin III (AT III), slight platelet aggregation and fibrinolytic activity remained. The hypercoagulability increased markedly again immediately after the operation and a correlation between hemorrhage and the rate of decrease in platelet count (PLT) was noted. A marked decrease in PLT and/or AT III immediately after the operation often warned of multiple organ failure and/or insufficiency of anastomosis. The postoperative hypercoagulable state was reversed within a week in uneventful cases, while it was delayed in cases complicated by multiple organ failure and/or insufficiency of anastomosis.

Key words
perioperative period of obstructive jaundice

Reprint requests
Akira Usuba First Department of Surgery, Fukushima Medical College
1 Hikarigaoka, Fukushima-city, 960-12 JAPAN

Accepted
September 12, 1990

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