Proposito Delia, Gramolini Roberto, Corazza Valerio, Mancini Barbara, Gallina Stefano, Montemurro Leonardo, Veltri Salvatore, Carboni Manlio
Divisione di Chirurgia Generale A, Dipartimento di Chirurgia Generale, Specialità Chirurgiche e Trapianti d'Organo Paride Stefanini.
Chir Ital. 2002 Jan-Feb;54(1):41-50.
It has been reported that patients who refuse blood transfusions, such as Jehovah's witnesses, can undergo major surgery. In a review of the literature, however, we critically examined the severity of anaemia in relation to operative mortality and morbidity rates. We report three cases of Jehovah's witnesses who underwent major surgery and presented complication during the postoperative period. Case 1: a 50-year-old man with oesophageal achalasia who underwent Heller's myotomy and Nissen's fundoplication. The postoperative period was complicated by massive haemorrhage and the patient was reoperated on postoperative day 1. After four years, he underwent total oesophagectomy because of severe chronic oesophagitis. On postoperative day 13 the patient suffered anteroseptal myocardial ischaemia, which was treated with medical therapy. Case 2: a 40-year-old man, admitted for ulcerative rectocolitis, who underwent total colectomy. On postoperative day 1 he presented massive haemorrhage and shock. He was reoperated and the postoperative period was complicated by myocardial ischaemia, renal failure and an enterocutaneous fistula. Case 3: a 65-year-old woman with ulcerative rectocolitis who underwent total colectomy and a temporary ileostomy. She suffered venous thrombosis of the lower limbs and pulmonary oedema. The patient died 14 months after surgery as a result of massive haemolysis by cryoagglutinins and cardiac arrest.
据报道，拒绝输血的患者，如耶和华见证会成员，也可以接受大手术。然而，在对文献的综述中，我们严格审查了贫血的严重程度与手术死亡率和发病率之间的关系。我们报告了3例接受大手术的耶和华见证会成员，他们在术后出现了并发症。病例1：一名50岁患有食管失弛缓症的男性，接受了贲门肌切开术和nissen胃底折叠术。术后出现大量出血并发症，患者在术后第1天再次接受手术。4年后，由于严重的慢性食管炎，他接受了全食管切除术。术后第13天，患者出现前间隔心肌缺血，接受了药物治疗。病例2：一名40岁因溃疡性直肠结肠炎入院的男性，接受了全结肠切除术。术后第1天，他出现大量出血和休克。他再次接受手术，术后出现心肌缺血、肾衰竭和肠皮肤瘘等并发症。病例3：一名65岁患有溃疡性直肠结肠炎的女性，接受了全结肠切除术和临时回肠造口术。她出现下肢静脉血栓形成和肺水肿。患者在手术后14个月因冷凝集素引起的大量溶血和心脏骤停死亡。
