用贺斯替代异体输血对肿瘤患者围术期免疫系统的影响

目的:探讨用血浆代用品6%贺斯(HAES)替代异体输血对肿瘤患者围术期免疫系统的影响.方法:将60例恶性肿瘤切除术患者,随机分为两组:输血组30例(B组);输贺斯组30例(H组).分别于麻醉诱导前,术后第3天及第7天抽取患者外周静脉血,应用酶联免疫吸附法(ELISA)进行细胞因子sIL-2R和IL-2浓度的测定并以乳酸脱氢酶释放法进行NK细胞活性的检测.结果:sIL-2R两组均上升B组更为明显,差异显著(P＜0.05);IL-2和NK细胞活性B组术后均明显下降(P＜0.05),H组手术前后比较均无明显变化.结论:术中输异体血后抑制患者体内抗肿瘤免疫系统;而输贺斯则对体内抗肿瘤免疫系统无不良影响.     

围手术期输血对肾癌术后患者预后影响的Meta分析

目的:系统评价围手术期输血(perioperative blood transfusion,PBT)对肾癌术后患者预后的影响.方法:检索从建库至2021年06月关于接受PBT的肾癌手术患者与未接受PBT患者对比分析的相关文献,检索数据库包括Pubmed、Embase、Cochrane library、中国生物医学文献数...     

围手术期输血对胃癌患者预后的影响

目的：探讨围手术期输血对中国人胃癌预后的影响。方法：将676例胃癌患者分为输血组和非输血组,统计学分析输血与临床病理参数的关系以及在胃癌患者预后中的价值。结果：51％（347／676）患者需输血,49％（329／676）患者不需输血。围手术期输血与年龄（≥60岁）、肿瘤大小（≥6cm）、上区和中区部位胃癌、R1、术前贫血呈正相关（P〈0．05）;输血组患者较未输血组浸润深度更深、淋巴结转移率更高以及疾病分期更晚（P〈0．05）。单因素生存分析发现未输血组患者预后显著好于输血组胃癌患者（P〈0．001）;根据TNM分期、术前贫血有无和肿瘤大小分层,Ⅱ和Ⅲ期患者中未输血组和输血组的生存时间差异显著（〉58个月vs．58个月,P=0．0064和29个月vs．20个月,P=0．0071）,而在Ⅰ和Ⅳ期患者中未发现生存差异（〉67个月vs．〉62个月,P=0．2070和16个月vs．10个月,P=0．3235）;≤6cm组和〉6cm组中未输血组和输血组生存时间均存在显著差异（〉52个月vs．30个月,P〈0．001和43个月vs．17个月,P=0．0019）;贫血组和非贫血组中未输血组和输血组生存时间均存在显著差异（39个月vs．20个月,P=0．0072和〉52个月vs．29个月,P〈0．001）。多因素生存分析显示年龄、浸润深度、淋巴结转移、TNM分期和围手术期输血均是影响胃癌患者预后的独立因素。结论：围手术期输血是影响胃癌患者预后的独立因子,其中对Ⅱ和Ⅲ期胃癌患者的影响更大,而且其影响力度不受肿瘤大小和患者的整体状况的影响,这为临床上合理输血及适度治疗提供了一定的参考。     

食管癌患者围术期输血对免疫功能的影响及不输血的可能性

目的　探讨食管癌患者围术期输血对免疫功能的影响及不输血的可能性。方法　对 10 5例围术期输血与 15 0例围术期未输血的食管癌患者的围术期用血量 ,术中出血量 ,术前、后外围血Hb含量 ,RBC、BPC计数 ,BT、CT、T淋巴细胞亚群CD+ 3 CD+ 4CD+ 8CD+ 4/CD+ 8进行比较。结果　输血组与未输血组Hb含量 ,RBC、BPC计数 ,BT、CT测定无差异 (P >0 0 5 ) ,出血量无明显差异 ( 36 0 +5 0ml与 330 +5 0ml ,P >0 0 5 ) ,围术期库用血量有极显著差异 (P <0 0 5 ) ,输血组患者术后免疫学指标受抑程度明显重于未输血 (P<0 0 5 )。结论　食管癌手术围术期输血可进一步加剧术后机体免疫功能受抑程度 ,只要手术操作熟练 ,可以减少或避免库存血的输入量。客观上存在不输血顺利完成的可能性 ,食管癌手术围术期不输血不影响手术质量 ,且有利于恢复     

浅谈肿瘤临床治疗中的合理输血

目的探讨肿瘤临床治疗中输血的合理性.方法对输血资料回顾性分析.结果至少有12%为不合理输血,24%有避免输血的可能性,64%为比较合理输血.结论目前肿瘤临床治疗中输血指征"偏宽",这不但浪费了宝贵的血液资源,更重要的是给患者带来得不偿失的远近期输血不良反应或并发症,因此,应严格掌握肿瘤患者的输血指征,提高输血治疗的质量.     

癌症患者围手术期输血的副作用

在证据表明围手术期输血可增加大手术后感染并发症的发生率及恶性肿瘤中根治术后的复发率，这与输血所致的免疫抑制有关。有作者成为成分输血可能降低术后免疫抑制，如过滤全血，浓缩红细胞，白细胞，人造介质红细胞悬液及血浆等。     

肿瘤患者围手术期预防性应用抗生素调查分析

目的 了解肿瘤患者围手术期预防性应用抗生素情况,为加强抗生素的合理使用和规范管理提供依据.方法 调查我院2009年下半年出院的514例经手术治疗的肿瘤患者的住院病历,对抗生素的应用情况进行统计分析.结果 514例患者中,围手术期预防性用药者510例(99.22%),药物应用频次前3位的依次为阿洛西林、头孢呋辛及头孢他啶.510例预防性用药者中,术前0.5～2 h均用药,用药率100.00%;术后继续用药者185例(36.27%),平均用药时间2.6 d.结论 肿瘤患者手术预防用药存在使用率高、种类选择欠妥及用药时间过长等问题.应针对问题,抓住重点,进一步规范管理,促进抗生素合理使用.     

异体输血对围术期肺部恶性肿瘤患者凝血功能影响的研究

目的探究异体输血对围术期肺部恶性肿瘤患者凝血功能的影响。方法对130例肺癌患者围手术期的凝血、纤溶功能相关指标水平进行检测,并纳入100例肺部良性病变患者作为对照组,分析异体输血对凝血功能的影响。结果肿瘤分期Ⅰ/Ⅱ期患者、Ⅲ/Ⅲ期患者的凝血、纤溶功能相关指标水平与对照组相比,差异有统计学意义(P<0.05);围手术期输血患者、未输血患者的凝血、纤溶功能相关指标水平与对照组相比,差异有统计学意义(P<0.05);多因素回归分析显示,肿瘤分期、围手术期输血是影响凝血、纤溶功能相关指标水平变化的显著因素(P<0.05)。结论围手术期肺癌患者存在明显的凝血功能异常,与是否异体输血密切相关,应引起临床重视。     

输血与肿瘤复发的相关性

输血是临床应用广泛的治疗恶性肿瘤的手段,但输血引起的术后肿瘤复发等后果往往被人们所忽视,其作用是由血液成分中的一种或多种免疫抑制成分所引起的.近年研究表明,输血对受体的免疫调节起着双重作用,一方面可使移植成活时间延长,另一方面也可能引起肿瘤复发.有关输血对肿瘤患者预后影响的回顾性临床研究已相继开展;动物实验也在分子生物学水平取得了机制研究的新突破.在积极开展前瞻性研究的同时,应严格输血指征,提倡自体输血或成分输血,以减少输血对肿瘤患者预后的不良影响.     

No detrimental effect of perioperative blood transfusion on recurrence in 2905 stage II/III gastric cancer patients: A propensity-score matching analysis

BackgroundThe effects of perioperative blood transfusion on the prognosis of gastric cancer patients remain controversial. This study aimed to assess the association between perioperative blood transfusion and survival outcomes.MethodsThe study included 2905 patients who underwent curative gastrectomy for stage II/III gastric cancer between 2006 and 2015 and were followed until 2018. Propensity-score matching was used to adjust for differences in baseline clinicopathologic characteristics between patients with or without blood transfusion.ResultsOf 2905 patients, 543 (18.7%) received a perioperative blood transfusion. Patients with blood transfusion had significantly worse overall survival and recurrence-free survival than those without blood transfusion (p < 0.001 for both). Survival outcomes did not differ according to timing of transfusion (preoperative, intraoperative, or postoperative), transfused volume (1–2 units of packed red cells vs ≥ 3 units of packed red blood cells), and volume of intraoperative blood loss (≤300 mL vs > 300 mL). After propensity-score matching adjusting for risk factors associated with blood transfusion, 498 patients were included in each group. Long-term recurrence-free survival was not significantly different between patients with or without blood transfusion in the matched analysis (p = 0.808).ConclusionsIn propensity-score matched analysis, blood transfusion was not associated with recurrence-free survival. Clinical circumstances, including demographic, pathologic, and surgical characteristics, rather than blood transfusions, appear to be the main prognostic factors for recurrence.     

30例肺癌再切除术的外科疗效分析

目的：对30例肺癌再切除手术患者进行回顾性分析,探讨其手术指征、并发症和生存率。方法：回顾分析1995年1月至2008年12月我院进行的余肺切除术30例的临床资料。应用生命表法计算1年、3年、5年生存率。结果：本组患者无手术死亡,术后并发症15例,涉及呼吸系统症状的10例（33.3%）,非呼吸系统5例（8.3%）,其中3例患者出现心律失常,1例心力衰竭,1例中度贫血。术后1、3、5年生存率为79.32%、67.25%、32.56%。结论：严格掌握余肺切除术的适应症,对于合适的患者而言,可获得较好的远期生存。     

30例肺癌再切除术的外科疗效分析

目的:对30例肺癌再切除手术患者进行回顾性分析,探讨其手术指征、并发症和生存率。方法:回顾分析1995年1月至2008年12月我院进行的余肺切除术30例的临床资料。应用生命表法计算1年、3年、5年生存率。结果:本组患者无手术死亡,术后并发症15例,涉及呼吸系统症状的10例(33.3%),非呼吸系统5例(8.3%),其中3例患者出现心律失常,1例心力衰竭,1例中度贫血。术后1、3、5年生存率为79.32%、67.25%、32.56%。结论:严格掌握余肺切除术的适应症,对于合适的患者而言,可获得较好的远期生存。     

General perioperative management of gastric cancer patients at high-volume centers

Background

Gastric cancer is very common in Korea and Japan, where many hospitals annually perform high numbers of gastrectomies for gastric cancer. The aim of this study was to compare the general management of gastric cancer in high-volume centers in Korea and Japan.

Methods

We undertook a survey of the general management of gastric cancer at high-volume centers (over 200 cases/year) and analyzed the answers.

Results

In six of 14 hospitals surveyed, antimicrobial prophylaxis for elective gastrectomy was administered until postoperative day 3. A Levin tube and an abdominal drain were routinely inserted in seven and ten hospitals, respectively. Laboratory tests, such as complete blood cell count, liver function test, electrolytes, and blood urea nitrogen/creatinine were performed frequently on postoperative days 1, 2, 3, and 5. Sips of water after open distal gastrectomy were restarted up to postoperative day 3 in twelve hospitals. The surgical pathology was reported up to postoperative day 10 in thirteen hospitals. Twelve hospitals provided a regular patient education program and only one hospital provided an integrated education program which included the participation of a surgeon, an oncologist, a nurse, and a nutritionist.

Conclusions

The general management of gastric cancer in 14 high-volume centers was not so different among the centers. The general management protocols noted here are expected to provide useful information for perioperative care.     

Influence of Perioperative Blood Transfusion on Prognosis in Patients with Colon Cancer

Objective： To explore the influence of perioperative blood transfusion on the postoperative survival of patients with colon cancer. Methods： Univariate and multivariate retrospective analyses were performed on the survival in a total of 723 colon cancer patients which were treated surgically during a period of 10 years. Results： Kaplan-Meier estimates showed that more than 800 mL perioperative blood transfusion was the survival predictor. Blood transfusion influenced significantly the prognosis of patients 40 years old and younger, those undergoing helicoloectomy left side, those with papillary adenocarcinoma, those with big tumors （diameter ≥ 8 cm）, those with stage Ⅰ tumors, those with lymphatic node metastases and those without liver metastases. In multivariate analysis only the tumor location, radicality of operation, lymphatic invasion, liver metastasis, depth of tumor invasion and TNM stage retained their significance. Conclusion： Perioperative blood transfusion is some extent. The indication of blood transfusion the prognostic factor for patients with colon cancer to must be restricted strictly, specially in patients younger than 40 years old, with right side lesion, papillary adenocarcinoma, big tumors （diameter ≥8 cm）, stage Ⅰ tumors and lymphatic node metastases or without liver metastases. But perioperative blood transfusion may not be deleterious for patients with staging Ⅳ disease and with distant metastases.     

高龄肺癌58例的外科治疗及围手术期处理

目的：探讨高龄肺癌外科治疗与围手术期处理的有关问题。方法：回顾分析手术治疗的58例70岁以上肺癌病例。结果：手术切除56例(96．6％)，其中根治性切除48例(85．7％)，姑息性切除8例(14．3％)。探查2例(3．4％)。术后并发症50例(86．2％)，围手术期手术死亡2例，病死率3．4％。结论：高龄并非是决定肺癌患者采取手术治疗的禁忌。重视合并症的诊断和治疗、充分的术前准备、合理选择手术时机与手术方式、加强术中与术后监测和防治并发症，是减少术后并发症和病死率、提高根治性切除率、生存率和改善生存质量的关键。     

血栓弹力图在胃癌患者围手术期监测中的意义

目的：探讨应用血栓弹力图（thromboelastogram ,TEG ）监测胃癌患者围手术期凝血功能的动态变化及其临床意义。方法：选取2014年3 月至2015年5 月期间在新乡市中心医院确诊为胃癌并行手术的178 例患者为试验组,并按肿瘤不同分期、不同浸润深度及有无淋巴结转移进行分组,对所有手术患者进行术前、术后TEG 动态监测,另选取60例健康体检者为正常对照组,行TEG 检测,通过对比分析其围手术期凝血功能变化。结果：实验组术前、术后与对照组比较,其TEG 参数R 、K 值明显减小,Angle、MA、CI值则显著增大,差异具有统计学意义（P < 0.05）。 实验组患者术前、术后对比K 值显著降低;Angle值、MA、CI 显著升高（P < 0.05）。R 、LY30等观测值均无显著变化。肿瘤不同分期、不同浸润深度及有无淋巴结转移的患者相比较,其TEG 监测值均有显著性差异。结论：胃癌患者围手术期表现为高凝状态,且与患者肿瘤分期、浸润深度及淋巴结转移呈正相关。动态监测胃癌围手术期TEG 可为临床提供有价值的凝血信息,并对提高胃癌手术的安全性和降低术后相关并发症有积极的临床意义。     

Cost analysis of a patient blood management program for patients undergoing gastric cancer surgery

Patient Blood Management (PBM) programs have probed to reduce blood transfusions and postoperative complications following gastric cancer resection, but evidence on their economic benefit is scarce. A recent prospective interventional study of our group described a reduction in transfusions, infectious complications and length of stay after implementation of a multicenter PBM program in patients undergoing elective gastric cancer resection with curative intent. The aim of the present study was to analyze the economic impact associated with these clinical benefits. The mean [and 95% CI] of total healthcare cost per patient was lower (?1955 [-3764, ?119] €) after the PBM program implementation. The main drivers of this reduction were the hospital stay (?1847 [-3161, ?553] €), blood transfusions (?100 [-145, ?56] €), and post-operative complications (?162 [-718, 411] €). Total societal cost was reduced by ?2243 [-4244, ?210] € per patient. These findings highlight the potential economic benefit of PBM strategies.