445例腹膜肿瘤细胞减灭术加腹腔热灌注化疗围手术期的输血管理

Management of perioperative blood transfusion in 445 patients with peritoneal carcinomatosis treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

目的探讨肿瘤细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC)(CRS+HIPEC)应用于腹膜癌围手术期的输血总体情况与综合止血技术临床疗效。方法以"首都医科大学附属北京世纪坛医院腹膜肿瘤外科临床科研数据库"中采用CRS+HIPEC治疗445例腹膜癌病例资料为研究对象,分析患者的临床病理特征和围手术期输血情况,进而对器官切除数量、腹膜剥除区域数量与围手术期输血量做相关性分析;为分析输血变化情况,按照手术日期顺序、肿瘤中心手术例次对患者收益程度影响的学习曲线规律,将患者分为第1时间段(2015.4.28—2017.3.1)组(n=220)和第2时间段(2017.3.2—2018.1.24)组(n=225),比较二者围手术期输血量。结果本组患者的术中红细胞、血浆输注量约占围手术期总量的73.26%(1 564 U/2 135 U)、80.14%(276 500 mL/345 000 mL)。术中、围手术期红细胞输注量与器官切除数量呈正相关性均为(r=0.24,P<0.05),血浆输注量与腹膜剥除区域数量亦呈正相关性(r值分别为0.37、0.38,P>0.05)。第1、2时间段术中输血量,分别为红细胞(U):3.9±3.8 vs 3.1±3.0(P<0.05);血浆(mL):673.6±450.2 vs570.2±371.6(P=0.01)。结论 CRS+HIPEC围手术期患者的输血量与器官切除数量、腹膜剥除区域数量呈正相关,术中综合止血技术可减少这类手术围手术期输血需求。

Objective To analyzes the general situation of blood transfusion during CRS+HIPEC, and evaluates the clinical efficacy of integrated homeostasis techniques. Methods The clinic-pathological features and perioperative blood transfusion details of 445 patients were analyzed from an established database: 'Clinical Research Database of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University'. The transfusion details of red blood cells and plasma were individually analyzed for the operation period and post-operation period for 7 days. Correlation study was conducted on the number of organ resection, peritoneal areas removedwith blood transfusion volume. To compare the changes in blood transfusion, the data was divided into 2 periods based on the learning curve principle with the impact of surgical volume of centers on postoperative outcomes: the first period(2015.4.28—2017.3.1) containing 220 cases, and the second period(2017.3.2—201.1.24) containing 225 cases. Results Amongthe 445 patients, 73.26%(1 564 U/2 135 U)of the red blood cells transfusion, and 80.14%(276 500 mL/345 000 mL) of theplasma transfusion occurred during the operation period. During the operation and perioperativeperiod, positive correlation coefficient between the number of organ resection and the RBC transfusion volume was both 0.24.The coefficient number of peritoneal areas removed and plasma transfusion was respectively 0.37, 0.38. Blood transfusion during operation of the first and second periods were respectively: RBC(U) 3.9±3.8 vs 3.1±3.0(P=0.01),plasma(mL)673.6±450.2 vs 570.2±371.6(P=0.01). Conclusions For CRS+HIPEC, the blood transfusion is positively correlated with the number of organ resection and peritoneal areas removed. Integrated homeostasis techniques during the operation could reduce the transfusion need perioperatively.