肺癌切除术中失血对长期生存的影响。
Impact of intraoperative blood loss on long-term survival after lung cancer resection.
作者信息
Nakamura Haruhiko, Saji Hisashi, Kurimoto Noriaki, Shinmyo Takuo, Tagaya Rie
机构信息
Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
出版信息
Ann Thorac Cardiovasc Surg. 2015;21(1):18-23. doi: 10.5761/atcs.oa.13-00312. Epub 2014 Feb 28.
PURPOSE
The purpose of this study was to clarify relationships between intraoperative blood loss (IBL) and long-term postsurgical survival in lung cancer patients.
METHODS
We retrospectively analyzed 1336 patients undergoing surgery: lobectomy in 1016, sublobar resection in 174, pneumonectomy in 106, and combined resection with adjacent organs in 40. The lobectomy group was stratified further by pathologic stages; overall survival difference was examined according to amount of IBL.
RESULTS
Volume of IBL differed significantly according to surgical procedure when all patients were included. Within the lobectomy group, IBL differed significantly between gender, pathologic stage, histologic type (adenocarcinoma vs. non-adenocarcinoma), and year of operation (1983 to 2002 vs. 2003 to 2012). After stratification by pathologic stage, survival differed with IBL for stages IB to IIIB. Multivariate analysis identified gender, patients age (<69 vs. ≥69), pathologic stage (IA to IIB vs. IIIA to IV), year of operation, histologic type, and IBL as significant predictors of survival.
CONCLUSION
Since degree of IBL is an independent predictor of overall survival after lung cancer resection, IBL should be minimized carefully during surgery.
目的
本研究旨在阐明肺癌患者术中失血量（IBL）与术后长期生存之间的关系。
方法
我们回顾性分析了1336例接受手术的患者：肺叶切除术1016例，肺段切除术174例，全肺切除术106例，联合相邻器官切除术40例。肺叶切除术组根据病理分期进一步分层；根据IBL量检查总生存差异。
结果
当纳入所有患者时，IBL量根据手术方式的不同有显著差异。在肺叶切除术组中，IBL在性别、病理分期、组织学类型（腺癌与非腺癌）以及手术年份（1983年至2002年与2003年至2012年）之间存在显著差异。按病理分期分层后，IBL在IB期至IIIB期患者的生存情况有所不同。多因素分析确定性别、患者年龄（<69岁与≥69岁）、病理分期（IA期至IIB期与IIIA期至IV期）、手术年份、组织学类型和IBL是生存的显著预测因素。
结论
由于IBL程度是肺癌切除术后总生存的独立预测因素，因此在手术期间应谨慎将IBL降至最低。
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