Objective:To investigate the clinical features of patients with distal cholangiocarcinoma who developed bleeding after pancreaticoduodenectomy (PD) and assess the predictive value of thromboelastography (TEG) in postoperative bleeding.Methods:Clinical data of 162 patients with distal cholangiocarcinoma who underwent PD in the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to August 2018 were retrospectively analyzed. Among them, 100 patients were male and 62 female, aged from 39 to 78 years, with a median age of 64 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the bleeding group (n=29) and non-bleeding group (n=133) according to whether postoperative bleeding occurred. Perioperative conditions between two groups were compared by rank-sum test or Chi-square test. Patients' tumor markers, coagulation function and TEG-related indexes were included in the analysis of influencing factors of postoperative bleeding. The independent influencing factors of postoperative bleeding were identified by univariate and multivariate Logistic regression analyses. Logistic regression model was established, and predictive value of this model was evaluated by ROC curve.Results:Pancreatic fistula, gastric emptying disturbance and 90-d mortality occurred in 19, 25 and 5 cases in the bleeding group, whereas 79, 57 and 3 cases in the non-bleeding group, significant differences were observed between two groups (χ2=32.874, 17.899, 11.390; P<0.05). In the bleeding group, the median length of ICU stay and length of postoperative hospital stay were 2(0, 4) d and 22(17, 34) d, significantly longer than 1(0, 2) d and 16(14, 19) din the non-bleeding group (Z=2.014, 4.005; P<0.05). Multivariate Logistic regression analysis showed that coagulation time K and Plt measured by TEG were the independent influencing factors of bleeding after PD in patients with distal cholangiocarcinoma (OR=0.193, 0.298; P<0.05). The area under the ROC curve of the model based on these two factors in predicting postoperative bleeding was 0.742 (95%CI:0.637-0.847).Conclusions:Patients with distal cholangiocarcinoma presenting with postoperative bleeding after PD are prone to pancreatic fistula, gastric emptying disorder and early death. The prediction model based on preoperative TEG measurement and Plt yields certain predictive value for postoperative bleeding.
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