食管癌手术个体化输血的可行性研究

Feasibility Study of Individual Blood Transfusion in Resectable Thoracic Esophageal Cancer

目的探讨笔者医院试行的输血指征下食管癌手术不输血是否安全有效。方法选取2013年1~12月食管癌手术病例,其中严格执行输血指征而未输血患者335例,根据医师临床经验用血患者217例,对两组患者围手术期相关指标进行统计比较。结果未输血组在性别、年龄、体重、肿瘤部位、术前实验室检查(RBC、HB、HCT、PLT)、手术时间、术中出血量、清扫淋巴结数、术后拔管时间、住院时间及TNM分期、术后肺部感染、切口愈合不良等方面与输血组比较,差异无统计学意义(P>0.05);术后乳糜瘘及吻合口瘘少于输血组(P<0.05)。结论严格输血指征,施行个体化输血,以个体失血量及HB变化来评估是否输血,在笔者医院拟定的输血标准下,食管癌手术不输血是可行的,既不影响患者术后恢复又避免了输血的不利影响,值得推广应用。

Objective To investigate the safety and efficiency without blood transfusion in resectable thoracic esophageal cancer under the strict transfusion strategy.Methods A total of 552 cases underwent esophagectomy from January 2013 to December 2013 were explored( 335 without blood transfusions,217 with blood transfusions).Preoperative parameters were compared between the two groups.Results There were no statistical differences in age,gender,weight,tumor location,preoperative laboratory parameters( RBC,HB,HCT,PLT),operation duration,blood loss,the number of lymph node dissection,duration of chest tube drainage,post operation hospitalization duration,TNM stage,pulmonary infection and poor wound healing between the two groups( P > 0.05).However,rates of chylothorax and anastomotic fistula were significant lower in non-blood transfusion group( P < 0.05).Conclusion The strict indications of blood transfusion( hemoglobin concentration thresholds and blood loss variables),which trigger blood transfusion in esophagectomy are feasible.It is worthy of recommendation for reducing blood usage and without affecting the postoperative recovery of patients.