McCulloch T M, Glenn M G, Riley D, Weymuller E A
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle 98195.
Arch Otolaryngol Head Neck Surg. 1989 Nov;115(11):1314-7. doi: 10.1001/archotol.1989.01860350048013.
Recent increased concern regarding the risks of homologous blood transfusion led us to examine the use of blood products for head and neck tumor surgery. Major head and neck surgical procedures at three University of Washington (Seattle)-affiliated hospitals during 1987 were reviewed. Seventy-seven patients were identified. Parameters studied included the following: tumor site and stage, prior treatment, surgical procedure, preoperative and postoperative hematocrit values, estimated blood loss, operative and postoperative blood product use, and operative time. Data were grouped by procedure. Maxillectomy/midface procedures showed the highest average estimated blood loss (1037 mL) and the highest average blood use (1.5 units), followed by composite resections (883 mL and 0.8 units) and laryngectomies (724 mL and 0.9 units). When the data were subgrouped, larynogopharyngectomy (1450 mL and 4.0 units) and composite resection with mandibular swing (1300 mL and 1.0 units) showed the highest blood loss and blood product use. In the assessable groups, previous administration of radiation did not make a significant difference in blood loss or procedure time. However, blood loss correlated well with procedure time in all groups. The great majority of patients met all requirements to function as blood donors (84%). Sixty-five percent of patients met all criteria and used less than 2 units of blood, making autologous blood a reasonable option for the majority of patients with head and neck tumors.
近期对同种异体输血风险的关注度增加，促使我们研究头颈部肿瘤手术中血制品的使用情况。我们回顾了1987年在华盛顿大学（西雅图）附属的三家医院进行的主要头颈部外科手术。共确定了77例患者。研究的参数包括：肿瘤部位和分期、既往治疗情况、手术方式、术前和术后血细胞比容值、估计失血量、术中及术后血制品使用情况以及手术时间。数据按手术方式分组。上颌骨切除术/面中部手术的平均估计失血量最高（1037毫升），平均用血量也最高（1.5单位），其次是联合切除术（883毫升和0.8单位）和喉切除术（724毫升和0.9单位）。当数据进一步细分时，喉咽切除术（1450毫升和4.0单位）和下颌骨摆动联合切除术（1300毫升和1.0单位）的失血量和血制品使用量最高。在可评估的组中，既往接受放疗对失血量或手术时间没有显著影响。然而，所有组的失血量与手术时间都有很好的相关性。绝大多数患者符合献血者的所有要求（84%）。65%的患者符合所有标准且用血少于2单位，这使得自体血对于大多数头颈部肿瘤患者来说是一个合理的选择。
