血液回收机在肿瘤切除术中应用的临床观察

Use of blood salvage machine in oncologic surgeries: a clinical observation of 13 cases

目的 评价在肿瘤切除术中使用血液回收机的节约用血效果及肿瘤细胞血行播散的风险性。方法 总结 13例肿瘤切除术中使用血液回收机的节约用血效果及术后远期随访情况。结果 术中共回收浓缩红细胞 4 2 5 75ml,平均每例回收浓缩红细胞 32 75ml(40 0～ 15 0 0 0ml) ,平均每例输库血 15 30ml(0～ 80 0 0ml)。肿瘤切除术中使用血液回收机的病例数占同期使用血液回收机手术病例数的 8 6 % (13/15 2 )。其中恶性肿瘤手术 6例 ,包括肾癌根治、下腔静脉切开取癌栓 4例、卵巢癌细胞减灭术、肾上腺皮质癌切除术各 1例 ,分别占 2 6 % (4/15 2 )、0 7% (1/15 2 )和 0 7% (1/15 2 ) ;良性肿瘤手术 7例 ,包括脑膜瘤切除术 5例 ,嗜铬细胞瘤切除术 2例 ,分别占 3 2 % (5 /15 2 )和 1 3%(2 /15 2 )。围术期病死率 :7 7% (1/13)。术后肿瘤肝、肺转移率 15 4 % (2 /13)。结论 肿瘤切除术中应用血液回收机可提高节约用血效果 ,但在恶性肿瘤切除术中应用血液回收机有可能导致肿瘤细胞经血液循环播散 ,不宜常规使用。

Objective To evaluate the effects on blood sparing and risk of hematogenous tumor dissemination of the use of blood salvage machine in oncologic surgeries. Methods The clinical data of 13 patients, 6 with malignant tumors and 7 with benign tumors, who received the use of blood salvage machine during oncologic surgeries based on informed consent, were analyzed. Results In total 42 575 ml of packed red blood cells were collected during surgery with a mean value of 3 275 ml (400～1500 ml) per patient. The average amount of allogenic transfusion per patient was 1 530 ml (0～8 000 ml). The number of blood salvage machine use in oncologic surgeries accounted for 8.6% (13/152) of the total number of blood salvage machine use in surgeries in that period. The perioperative mortality rate of the oncologic surgeries with the use of blood salvage machine was 7.7% (1/13). The post-operative metastasis rate of liver and lung was 15.4% (2/13). Conclusion The use of blood salvage machine during oncologic surgeries improves the blood sparing effect. However, it cannot be used routinely, since it may result in hematogenous tumor cell dissemination.