門脈圧亢進症の手術と凝固・線溶系の推移--病態生理学的・臨床的考察

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Pre and post-operative changes of the hemostatic functions in 15 patients with portal hypertension were studied, with reference to liver cirrhosis and postoperative jaundice. The tests included APTT (sec), PT (%), fibrinogen (Fbg) (mg/dl), FDP (μg/ml), plasma antithrombin III (AT III)·serum plasminogen (Plg)·α1 antitrypsin(α1 AT)·α2 macroglobulin (α2 M) (mg/dl), α2 plasmin inhibitor (α2 PI) and platelet (Plat) (104/mm3). The results indicate the pathophysiological and clinical significances as follows: 1) All patients were in the hypocoagulable state, with or without liver cirrhosis. 2) In liver cirrhotic groups, on the preoperative evaluations, almost of those with APTT≥44, PT≤60, Fbg≤170, AT≤15 and α2 PI≤65 were prone to be in jaundice, and those with PT≤50, AT III≤12 and Plg≤5 were died, postoperatively. 3) Postoperatively, hemostatic functions returned to normal in almost all tests in the non-cirrhotic group, but only in APTT, Fbg and Plat in the cirrhotic ones. 4) Hypercoagulability which were seen in the patients postoperatively were prominent in non-cirrhotic groups. 5) The hemostatic abnormalities in the patients with postoperative jaundice and hepatic failure were not DIC but disorders in the production of the hemostatic elements. 6) Post-operative changes of it reflect the progression and prognosis of hepatic failure.
社団法人日本肝臓学会の論文