Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Hepatobiliary Pancreat Sci. 2018 Dec;25(12):550-559. doi: 10.1002/jhbp.592. Epub 2018 Dec 11.
It remains unclear whether preoperative blood donation is truly beneficial in liver surgery. The aim of this study was to compare surgical outcomes between patients receiving autologous and homologous transfusions during liver resection for biliary tract cancer (BTC).
Patients who underwent hepatectomy for BTC were retrospectively reviewed (2006-2017). Patients who deposited autologous blood and underwent resection without homologous blood transfusion intraoperatively (Autologous group) were compared with non-depositing patients who required homologous transfusion during hepatectomy (Homologous group). Propensity score matching analyses were performed to adjust the data for the baseline characteristics of both groups.
During the study period, 359 patients were included in the Autologous group, and 105 patients were in the Homologous group. The postoperative maximum total bilirubin (T-Bil) levels and the incidence of postoperative liver failure were significantly higher in the Homologous group than in the Autologous group. After propensity score matching, postoperative maximum T-Bil levels were significantly higher in the Homologous group, whereas the incidence of postoperative liver failure was comparable between the two groups; between-group differences were not observed for the remaining major complications, hospital stays and mortality.
Although autologous blood transfusion may minimize postoperative hyperbilirubinemia, it may not decrease the risk for mortality or morbidities following hepatectomy for BTC.
术前献血是否对肝切除术真正有益尚不清楚。本研究旨在比较胆道癌（BTC）肝切除术中接受自体输血和同种异体输血患者的手术结果。
回顾性分析 2006 年至 2017 年间接受 BTC 肝切除术的患者。将术中未输注同种异体血但储存自体血的患者（自体血组）与术中需要同种异体输血的未储存患者（同种异体血组）进行比较。采用倾向评分匹配分析调整两组基线特征数据。
研究期间，自体血组纳入 359 例患者，同种异体血组纳入 105 例患者。同种异体血组术后最大总胆红素（T-Bil）水平和术后肝功能衰竭发生率明显高于自体血组。在进行倾向评分匹配后，同种异体血组的术后最大 T-Bil 水平明显更高，而两组术后肝功能衰竭发生率相当；两组之间的其他主要并发症、住院时间和死亡率没有差异。
尽管自体输血可能会最小化术后高胆红素血症，但它可能不会降低 BTC 肝切除术后的死亡率或发病率。
