Shiba Hiroaki, Ishida Yuichi, Fujiwara Yuki, Wakiyama Shigeki, Gocho Takeshi, Ito Ryusuke, Sakamoto Taro, Tsutsui Nobuhiro, lida Tomonori, Matsumoto Michinori, Furukawa Kenei, Haruki Koichiro, Hirohara Shoichi, Misawa Takeyuki, Yanaga Katsuhiko
Hepatogastroenterology. 2013 Oct;60(127):1681-3.
BACKGROUND/AIMS: Because recent studies have reported that allogenic blood transfusion exerts negative immunomodulatory effects, we tried decreasing the use of blood products in perioperative management of hepatic resection since 2003. We retrospectively assessed the changes in our blood transfusion policy on hepatic resection for hepatocellular carcinoma (HCC).
Subjects were 78 patients who underwent hepatic resection for HCC at Jikei University Hospital. Patients were classified into 2 groups; early period (2000-2002, n=25), and late period (2003-2006, n=53). Perioperative findings including age, gender, hepatitis virus, preoperative ICGR15, Child's classification, tumor factor, type of resection, duration of operation, blood loss, the amount of peri-operative red cell concentration (RC) and fresh frozen plasma (FFP) transfusion, incidences of post-operative complication, as well as disease-free and overall survival were analyzed.
The amount of perioperative RC (p=0.041) and FFP (p<0.001) transfusion in late period were significantly smaller and non-anatomical limited partial resection (p=0.004) in late period was greater than early period. The patients in late period had significantly better overall survival rate than those in early period (p<0.001).
Practice to minimize the use of blood products may improve patient's survival after hepatic resection for HCC.
背景/目的：由于近期研究报道异体输血具有负面免疫调节作用，自2003年起我们尝试在肝切除围手术期管理中减少血制品的使用。我们回顾性评估了肝细胞癌（HCC）肝切除输血策略的变化。
研究对象为78例在慈惠会医科大学医院接受HCC肝切除的患者。患者分为两组：早期（2000 - 2002年，n = 25）和晚期（2003 - 2006年，n = 53）。分析围手术期指标，包括年龄、性别、肝炎病毒、术前吲哚氰绿滞留率15分钟（ICGR15）、Child分级、肿瘤因素、切除类型、手术时长、失血量、围手术期红细胞悬液（RC）和新鲜冰冻血浆（FFP）输注量、术后并发症发生率以及无病生存期和总生存期。
晚期围手术期RC输注量（p = 0.041）和FFP输注量（p < 0.001）显著减少，晚期非解剖性局限性部分切除术（p = 0.004）高于早期。晚期患者的总生存率显著高于早期患者（p < 0.001）。
尽量减少血制品使用的做法可能会提高HCC肝切除术后患者的生存率。
