Makuuchi M, Takayama T, Gunvén P, Kosuge T, Yamazaki S, Hasegawa H
World J Surg. 1989 Sep-Oct;13(5):644-8. doi: 10.1007/BF01658893.
To evaluate the worth of intra- and postoperative blood transfusion in cirrhotic patients undergoing resection for hepatocellular carcinoma, we compared 13 patients receiving transfusions and 14 matched contemporary patients who did not receive blood. Preoperative hematological and biochemical parameters, the type and extent of liver resection, and the mean blood loss (862 and 870 ml) were similar in the 2 groups. The total volume of intra- and postoperative blood transfused ranged from 400 to 1,800 ml (mean, 1,223 ml) in the patients receiving transfusions. During various postoperative time intervals, the mean values of hematocrit, hemoglobin, serum total bilirubin, and lactic dehydrogenase activity were significantly higher in the patients who were transfused compared to those who were not. Mean serum transaminase activities were similar in the 2 groups at the same times. The mean hematocrit values decreased from 36.8% preoperatively to a postoperative minimum of 27.0% in the transfused group, and from 39.9% to 26.1% in the nontransfused group. Our experience and theoretical reasons have led us to withhold blood transfusion until the hematocrit values fall below 30% during hepatectomy and below 20% in the postoperative period (or unless circulatory instability cannot be corrected otherwise). Fresh frozen plasma is preferred for volume substitution and, if blood has to be given, only up to 60-70% of estimated losses should be replaced by fresh blood.
为评估肝细胞癌切除术后肝硬化患者术中及术后输血的价值，我们比较了13例接受输血的患者和14例同时期匹配的未接受输血的患者。两组患者术前血液学和生化指标、肝切除的类型和范围以及平均失血量（分别为862和870毫升）相似。接受输血的患者术中及术后输血总量为400至1800毫升（平均1223毫升）。在术后不同时间段，接受输血的患者的血细胞比容、血红蛋白、血清总胆红素和乳酸脱氢酶活性的平均值显著高于未输血患者。两组患者同期的平均血清转氨酶活性相似。接受输血组的平均血细胞比容值从术前的36.8%降至术后最低的27.0%，未输血组从39.9%降至26.1%。我们的经验和理论依据使我们在肝切除术中血细胞比容值降至30%以下、术后降至20%以下之前（或除非循环不稳定无法通过其他方式纠正）不进行输血。容量替代首选新鲜冰冻血浆，如果必须输血，新鲜血液替代量仅应为估计失血量的60 - 70%。
