[Disorders of hemostasis during partial hepatectomies. Study of 20 cases]

Changes in blood coagulation have been studied during and after 20 elective hepatic lobectomies, most of them for tumors necessitating extensive resection (17 right lobectomies, 10 of which were extended to the medial segment of the left lobe). In addition, 9 unresectable tumors, as proved by exploratory laparotomy, were taken for controls. Before operation, hemostasis in essentially normal except a hyperfibrinogenemia and a slight increase of fibrinogen split products in half the cases. Factor VIII antigen levels are consistently increased. During mobilization of the liver an increased fibrinolytic activity and soluble complexes are frequently observed. Fibrinolysic activity spontaneously returns to normal at the end of the operation, except in cirrhotic patients. No bleeding disthesis is observed and haemorrhage appears to be related to technical problems. On the other hand, there is no clinical evidence of thromboembolism after operation. Therefore any specific therapy either pro or anti-coagulant, appears unjustified, apart from the eventual and transient administration of antifibrinolytic drugs in cirrhotic patients. In the post operative period, blood clotting factors synthetized by the liver (prothrombin complex and antithrombin III) slowly return to normal. Rapid correction of hypo-accelerinaemia reflects the onset of liver regeneration. A simplified method for surveying hemostasis during and after liver resection is proposed.