食管癌手术个体化输血的可行性研究

摘要

Objective To investigate the safety and efficiency without blood transfusion in resectable thoracic esophageal cancer un -der the strict transfusion strategy .Methods A total of 552 cases underwent esophagectomy from January 2013 to December 2013 were ex-plored (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 hospi-talization duration, TNM stage, pulmonary infection and poor wound healing between the two groups (P>0.05).However, rates of chy-lothorax 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 .%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.