1967 Volume 58 Issue 5 Pages 516-525
To clarify the biological mechanism of occurrence of fibrinolytic phenomena at a surgical operation as well as the factors relating the surgical procedure, the fibrinolytic activity of peripheral blood of the cases who received a surgical operation on the genitourinary organs, especially a prostatectomy was observed. The method of determination was described previously in the second report.
1. The effect of surgical operation of the genitourinary organs on fibrinolytic activity was examined by the estimation of SK-pl. activity with St. -plate. There could be found a progressive decrease of the activity after surgery of the kidney or the urinary bladder, while it increased gradually during 24 hours after surgery of the ureter. Furthermore, clearly increased activity was already found 3 hours after a prostatectomy. On the other hand, not any significant change could be found when using H. -plate, in each case.
2. The course of the temporal increment of fibrinolytic activity after a prostatic surgery was analysed by the observation on the results of experimental prostatectomy in the rabbit. And an expansion of fibrinolytic area on St. -plate was confirmed only during 2-3 hours of the postoperative course. The same result was rather obviously found on SK-pl. activity, than plasmin activity.
3. The relation between the surgical factors in prostatic operation and the fibrinolytic activity in the blood was examined. Rather high SK. -pl. activities were found in the case with hen's egg-sized prostate, as well as the adenomas of 21-40g in weight, or the adenomas with severe adhesion. As to the surgical technique, the most high activity was found in the blood after TURP, then come transpubic total prostatectomy and retropubic prostatectomy.
With the results obtained above, it was assumed that the difference in the effect of surgical operation of different organs with fibrinolytic activity in the blood reveals the importance to be concerned about the direct effect of the operation itself as the factor affecting the fibrinolytic activity, except an emotional uneasiness, anesthesia, or fatigue at the operation.
With the experimental prostatectomy in the rabbit, it was clarified that the more significant apparence of the plasminogen activator or proactivator in the blood after the surgery was confirmed, than that of plasmin or plasminogen. And furthermore, with the analysis on the relation between the surgical factors of prostatectomy and postoperative fibrinolytic activity, some close relationship between the manipulation of the surgical capsule of the prostate during the surgical operation and the increase of fibrinolytic activity in the blood was assumed. And this reveals that the plasminogen activator and proactivator which appear in the blood after the prostatectomy would originate from the surgical capsule of the prostate.
