Zhang Chao, Fan Heng-Wei, Yi Wan-Wan, Zheng Zhi-Qiang
1 Department of General Surgery, The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou, China .
2 Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University , Shanghai, China .
J Laparoendosc Adv Surg Tech A. 2018 Mar;28(3):237-241. doi: 10.1089/lap.2017.0468. Epub 2017 Oct 24.
Laparoscopy-assisted gastrectomy (LAG) is a minimally invasive procedure for the treatment of gastric cancer. It is generally thought that a minimally invasive technique results in less visible blood loss during the surgery. Nevertheless, a meaningful perioperative hidden blood loss (HBL) is often ignored. In this study, we investigated the amount of HBL and the influential factors after LAG for gastric cancer.
A retrospectively analyzed clinical data of 62 consecutive patients who underwent laparoscopy-assisted total or distal gastrectomy at our center from May 2016 to May 2017. The HBL was calculated according to Gross's and Nadler's formula. The data of patient gender, age, height, weight, body mass index, preoperative and postoperative hematocrit, postoperative drainage, albumin loss, diabetes mellitus, and hypertension were analyzed by multivariate linear regression analysis. The type of surgical reconstruction was analyzed by one-way analysis of variance. The difference between the preoperative blood pressure and postoperative blood pressure was measured by paired sample t-test and boxplot.
The HBL was 322.2 ± 195.9 mL (64.3% ± 14.1% in total blood loss [TBL]), the TBL was 475.6 ± 222.8 mL, and the hemoglobin (HB) loss was 15.0 ± 8.7 (11.5% ± 6.1% of HB level loss). Multivariate linear regression analysis revealed that gender, hypertension, and albumin loss between preoperation and postoperation are influential factors of HBL in patients after LAG for gastric cancer. Compared to male patients, female patients are positively associated with HBL.
In our study, we found HBL is a significant segment of TBL and is much larger than what we considered previously in LAG for gastric cancer. Gender, hypertension, and albumin loss are significantly correlated with HBL. Therefore, paying attention to HBL is significant for promoting clinical treatment and ensuring patients' safety.
腹腔镜辅助胃切除术（LAG）是一种用于治疗胃癌的微创手术。一般认为，微创技术在手术过程中导致的可见失血量较少。然而，有意义的围手术期隐性失血（HBL）常常被忽视。在本研究中，我们调查了LAG治疗胃癌后的HBL量及其影响因素。
回顾性分析了2016年5月至2017年5月在我院中心连续接受腹腔镜辅助全胃或远端胃切除术的62例患者的临床资料。根据格罗斯（Gross）和纳德勒（Nadler）公式计算HBL。通过多因素线性回归分析患者性别、年龄、身高、体重、体重指数、术前和术后血细胞比容、术后引流、白蛋白丢失、糖尿病和高血压等数据。通过单因素方差分析手术重建类型。术前血压与术后血压的差异采用配对样本t检验和箱线图进行测量。
HBL为322.2±195.9 mL（占总失血量[TBL]的64.3%±14.1%），TBL为475.6±222.8 mL，血红蛋白（HB）丢失为15.0±8.7（占HB水平丢失的11.5%±6.1%）。多因素线性回归分析显示，性别、高血压以及术前和术后白蛋白丢失是LAG治疗胃癌患者HBL的影响因素。与男性患者相比，女性患者与HBL呈正相关。
在我们的研究中，我们发现HBL是TBL的重要组成部分，并且比我们之前在LAG治疗胃癌中所认为的要大得多。性别、高血压和白蛋白丢失与HBL显著相关。因此，关注HBL对促进临床治疗和确保患者安全具有重要意义。
