十二指肠乳头癌患者术前贫血与围术期输血情况分析

Investigation of preoperative anemia and perioperative blood transfusion in patients with duodenal papillarycarcinoma in a tertiary hospital

目的了解十二指肠乳头癌行Whipple手术患者术前贫血及围术期输血情况。方法回顾性分析1959例十二指肠乳头癌行Whipple手术患者临床资料。结果十二指肠乳头癌行Whipple手术患者术前贫血率为54.87%(1075/1959),从低到高3个年龄段患者贫血发生率分别为44.92%(≤50岁,190/423)、52.82%(51~64岁,506/958)、65.57%(≥65岁,379/578)(P<0.05),贫血率最高的年龄段为65岁以上。不同身体质量指数(BMI)患者贫血发生率也有较大的差异(P<0.05)。中重度贫血患者相比轻度贫血患者围术期输注了更多的红细胞(P<0.05)。输血患者平均住院时长为27.25d,未输血组为22.22d(P<0.05)。腹腔镜、机器人手术患者术中出血量、住院时长均显著低于开腹手术患者(P<0.05)。住院期间单纯使用药物进行贫血干预的患者仅占24.09%(186/772),大部分患者通过输血来干预贫血(75.91%,586/772)。结论十二指肠乳头癌行Whipple手术患者术前贫血发生率存在显著差异,BMI指数偏小、WBC异常、围术期输血均为住院时间延长的高危因素,而贫血则不会导致患者住院时间延长。

Objective To investigate the preoperative anemia and perioperative blood transfusion in patients with duodenal papillary carcinoma who underwent Whipple surgery.Methods The clinical data of 1959 cases with duodenal papillary carcinoma,subjected to Whipple surgery,were retrospectively analyzed.Results The rate of anemia in preoperative patients with duodenal papillary carcinoma was 54.87%(1075/1959).The incidence rate of anemia in the three age groups from low to high was 44.92%(≤50 years old,190/423),52.82%(51~64 years old,506/958),and 65.57%(≥65 years old,379/578)(P<0.05),and the highest rate of anemia occurred in patients aged above 65.There was a significant statistical difference among patients with different body mass index(BMI)(P<0.05).Patients with moderate or severe anemia received more red blood cells than patients with mild anemia during the perioperative period(P<0.05).The average hospitalization time of the blood transfusion patients was 27.25 days,and that of non-transfusion patients was 22.22 days(P<0.05).The amount of blood loss and hospitalization time of patients underwent laparoscopic and robotic surgery were significantly lower than those underwent open surgery patients(P<0.05).There were only 24.09%(186/772)treated with drugs for anemia intervention and the majority of patients(75.91%,586/772)were treated with blood transfusions to interfere with anemia during hospitalization.Conclusion There are significant differences in the incidence rate of preoperative anemia among patients with duodenal papillary carcinoma who undergone Whipple surgery.Low BMI,abnormal WBC,and perioperative blood transfusion are high-risk factors for prolonged hospital stay,whereas anemia is not associated with prolonged hospital stay.