Бюллетень сибирской медицины (Apr 2015)
EFFECT OF INTRAOPERATIVE USE OF ULTRALOW TEMPERATURES ON THE COAGULATION HEMOSTASIS STATE AFTER HEPATIC RESECTION, DEPENDING ON THE FUNCTIONAL STATUS OF LIVER
Abstract
The work has evaluated the impact of intraoperative cryotherapy on the coagulation indicators and the risk of hemorrhagic complications development after liver resection, depending on the original (preoperative) functional state of the organ and the resection method. 24 patients with liver lesions, aged 20 –55, have been operated; of them 9 patients had liver disorders prior to the surgery and 15 patients had no disorders. Half of the patients have undergone liver resection with cryotherapy, the remaining part of the patients have been exposed to conventional resection. The material for the research was venous plasma. According to the research findings, the post-operative dynamics of the coagulation indicators in the patients with liver lesions proves the advantage of using cryotherapy for minimizing the risk of hemorrhagic complications emergence. Thus, a tendency towards normalization of factors V, XI and XII content in blood plasma is more prominent after cryoresection of the liver, than after the conventional resection method (without cryotherapy). The international normalized ratio (INR) in the post-operative period exceeds the norm, regardless of the resection method and the functional state of the liver prior to the surgery. However, among the patients who had original liver disorder, INR is more than 2.0 before the surgery, whereas after the operation, despite the decrease, it remains above 1.4, which indicates significant hypocoagulation and high risk of hemorrhagic complications following the deficiency of the extrinsic coagulation pathway. Activated partial thromboplastin time after the surgery goes down, however, like before the surgery, it remains within the range of the commonly accepted reference values, regardless of the functional liver state and the resection method.
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