Factors affecting perioperative hemostatic abnormalities in prolonged maxillofacial surgery

• Project/Area Number: 11672020
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Surgical dentistry
• Research Institution: Nippon Dental University
• Principal Investigator: TAKASUGI Yoshihiro Nippon Dental University Dep.of Anesthesiology assistant professor, 歯学部, 講師 (90120683)
• Co-Investigator(Kenkyū-buntansha): NAKAMURA Miminari Nippon Dental University Dep.of Anesthesiology assistant professor, 歯学部, 講師 (80139295) ; ARAI Chiaki Nippon Dental University Dep.of Clinical laboratory assistant, 歯学部, 助手 (40139308)
• Project Period (FY): 1999 – 2000
• Project Status: Completed (Fiscal Year 2000)
• Budget Amount: ¥3,600,000 (Direct Cost: ¥3,600,000); Fiscal Year 2000: ¥1,100,000 (Direct Cost: ¥1,100,000); Fiscal Year 1999: ¥2,500,000 (Direct Cost: ¥2,500,000)
• Keywords: prolonged surgery / hypercoagulability / tissuo factor / interleukin 6 / vascular injury / malignant tumor / 血液線溶活性 / 組織型プラスミノゲンアクチベーター / プラスミンα2プラスミンインヒビター複合体 / サイトカイン / トロンボモジュリン / 血液凝固

Research Abstract

It is believed that the hemostatic abnormalities occur during prolonged surgery. Perioperative hypercoagulability is recognized as a result of the basic disease, the releasing tissue factor (TF) into the circulation due to the soft tissue invasion, the invasion of endothelial cell and so on. However, it has been unknown what factors eause the hemostatic abnormalities during prolonged surgery. In this study, we evaluated the perioperative changes of molecular markers for the purpose of the investigation of investigation of factors causing hemostatic abnormalities during prolonged surgery
The subjects was undergone prolonged malignant surgery, more than eight hours of duration, accompanied with a tumor dissection, a radical neek dissection and a reconstruetion by a free flap implantation. Molecular markers of prothrombin fragment 1+2 (F1+2), interleukin 6 (IL-6), TF, tissue factor pathway inhibitor (TFPI), thrombomodulin (YM), α2-plasmin inhibitor-plasmin complex (PAP), tissue-type plasmi nogen activator (tPA) were measured at the time of anesthesia start, the end of radial neek dissection, the end of tissue transplantation, the end of anesthesia, and the first and seeond postoperative days
We obtained the following results :
1. The values of F1+2 significantly increased during operation and declined postoperatively
2. The values of IL-6 and tPA also increased intraoperatively and reached the maximum at the end of anesthesia
3. The values of TF, TFPI, TM and PAP did not significant changed during and postoperatively.
These results reveal that the releasing cytokines into the circulation due to the surgical invasion influenced the hypercoagulability during the surgery, and is one of the factors causing hemostatic abnormalities. Furthermore, the surgical invation must enfluence to the endthelium to release tPA.However, since TF that has been recognized as a main factor to the hypercoagulation during surgery, and TM that is released by the significant degree of vascular injury did not significantly changed, the soft tissue invasion must not important to form the hypercoagulability during prolonged surgery in maxillofacial region.