Patients undergoing prolonged surgery for gynecological malignancies often develop peri- and post-operative complications affecting haemostasis, including disseminated intravascular coagulation (DIC). In this study, the dynamic processes of perioperative haemostasis from prolonged surgery for gynecological malignancies were examined in detail with special attention to the development and prognosis of DIC. Coagulation testing was performed on 23 patients undergoing surgery for malignancies of the lower genital tract preoperatively, at the end of surgery, and 6, 18 and 30 hours postoperatively. Analysis included partial thromboplastin time (PTT), prothrombin time (PT), thrombin time (TT), fibrinogen, D-dimer, antithrombin III and fibrin monomer. All patients showed signs of haemostatic abnormality. Preoperatively, compensated DIC with signs of hypercoagulation were evident. Postoperatively, DIC with micro- and macrothrombosis and bleeding, which developed during surgery, was observed, often persisting for more than 6 hours after surgery. Peri-operative incidence of DIC was much higher than suspected in earlier studies, but life-threatening bleeding complications did not occur in our study. Little difference in postoperative development of coagulation was noted in patients with and without DIC.
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