Moir M S, Samy R N, Hanasono M M, Terris D J
Department of Surgery, Stanford University Medical Center, Calif 94305-5328, USA.
Arch Otolaryngol Head Neck Surg. 1999 Aug;125(8):864-8. doi: 10.1001/archotol.125.8.864.
To determine if the use of autologous blood ameliorates the increased risk for cancer recurrence that has been associated with perioperative blood transfusion.
Retrospective medical record review.
Tertiary care hospital.
One hundred sixty-five consecutive patients with stages II to IV squamous cell carcinoma of the head and neck treated surgically at a university hospital from January 1, 1989, through December 31, 1994.
We evaluated the impact of perioperative autologous and heterologous blood transfusion and 10 other variables on recurrence. Univariate and multivariate analyses were used.
Heterologous blood recipients had a 59% recurrence rate, whereas those who had received autologous blood or no transfusion had recurrence rates of 33% and 35%, respectively. The following 4 variables had a statistically significant association with recurrence by multivariate analysis: previous treatment of current malignancy (P<.001); receipt of heterologous blood (P = .04); positive margin (P = .04); and nodal disease (P = .04). The receipt of heterologous blood was associated with a 40% increased risk for recurrence.
Autologous blood products should be used during head and neck cancer surgery if possible when transfusion is necessary.
确定使用自体血是否能改善与围手术期输血相关的癌症复发风险增加的情况。
回顾性病历审查。
三级护理医院。
1989年1月1日至1994年12月31日在一所大学医院接受手术治疗的165例连续的II至IV期头颈部鳞状细胞癌患者。
我们评估了围手术期自体和异体输血以及其他10个变量对复发的影响。采用单因素和多因素分析。
异体输血患者的复发率为59%，而接受自体血或未输血的患者的复发率分别为33%和35%。多因素分析显示，以下4个变量与复发有统计学意义的关联：当前恶性肿瘤的既往治疗情况（P<.001）；接受异体输血（P = .04）；切缘阳性（P = .04）；以及淋巴结疾病（P = .04）。接受异体输血与复发风险增加40%相关。
在头颈部癌症手术中，如果有必要输血，应尽可能使用自体血制品。
