接受细胞减灭术治疗晚期卵巢癌的耶和华见证人患者的围手术期血液管理。
Peri-operative blood management of Jehovah's Witnesses undergoing cytoreductive surgery for advanced ovarian cancer.
机构信息
Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy.
Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy.
出版信息
Blood Transfus. 2022 Mar;20(2):112-119. doi: 10.2451/2021.0416-20. Epub 2021 Feb 25.
BACKGROUND
The aim of this study was to evaluate the efficacy and feasibility of a peri-operative bloodless medicine and surgery (BMS) protocol in reducing severe post-operative anaemia (haemoglobin [Hb] <7 g/dL) in Jehovah's Witnesses undergoing cytoreductive surgery for advanced epithelial ovarian cancer.
MATERIALS AND METHODS
This was a single-institution retrospective study enrolling Jehovah's Witnesses who underwent elective bloodless surgery for advanced epithelial ovarian cancer between October 2017 and April 2020. All patients followed a standardised bloodless medicine and surgery protocol based on ferric carboxymaltose and erythropoietin if indicated.
RESULTS
Twenty-five patients with a mean age of 61.7 years (range, 35-80) were enrolled. Pre-operatively, ten patients (40%) were mildly anaemic (mean Hb of 10.2 g/dL [range, 9.2-11.4]) and received ferric carboxymaltose. Only four (16%) patients had severe anaemia after surgery (mean Hb of 6.1 g/dL [range, 4.1-6.9]) and received ferric carboxymaltose and erythropoietin. Compared to patients with a post-operative Hb ≥7 g/dL, those with Hb <7 g/dL had higher mean body mass index (25.8±1.8 vs 30.7±1.8 kg/m; p<0.001), mean baseline CA125 (236.1±184.5 vs 783.7±273.5 IU/mL; p<0.001), median surgical complexity score (2 vs 10; p<0.001), and rate of post-operative complications (14.3 vs 100%; p<0.001). Moreover, these patients had a longer mean operating time (3.4±0.6 vs 5.5±0.4 h; p<0.001), duration of stay in hospital (5.5±0.7 vs 24.0±9.8 days; p<0.001), and time to adjuvant chemotherapy (27.2±2.6 vs 65.3±13.4 days; p<0.001).
DISCUSSION
The use of a multidisciplinary bloodless medicine and surgery protocol is safe and effective in reducing the rate of severe post-operative anaemia and improving surgical and oncological outcomes of Jehovah's Witnesses with advanced epithelial ovarian cancer. Further large-scale, prospective studies are required to confirm these data.
背景
本研究旨在评估围手术期无血医学和手术（BMS）方案在减少接受细胞减灭术治疗晚期上皮性卵巢癌的耶和华见证人术后严重贫血（血红蛋白[Hb]＜7g/dL）方面的疗效和可行性。
材料和方法
这是一项单中心回顾性研究，纳入了 2017 年 10 月至 2020 年 4 月期间接受无血手术治疗晚期上皮性卵巢癌的耶和华见证人。所有患者均遵循基于三价铁羧基麦芽糖和促红细胞生成素的标准化无血医学和手术方案。
结果
共纳入 25 例患者，平均年龄 61.7 岁（35-80 岁）。术前，10 例患者（40%）轻度贫血（平均 Hb 为 10.2g/dL[9.2-11.4]），接受了三价铁羧基麦芽糖。仅 4 例（16%）患者术后出现严重贫血（平均 Hb 为 6.1g/dL[4.1-6.9]），接受了三价铁羧基麦芽糖和促红细胞生成素。与术后 Hb≥7g/dL 的患者相比，Hb＜7g/dL 的患者体重指数（BMI）平均值较高（25.8±1.8 vs 30.7±1.8kg/m；p＜0.001），基线 CA125 平均值较高（236.1±184.5 vs 783.7±273.5IU/mL；p＜0.001），手术复杂程度中位数较高（2 vs 10；p＜0.001），术后并发症发生率较高（14.3% vs 100%；p＜0.001）。此外，这些患者的平均手术时间较长（3.4±0.6 vs 5.5±0.4h；p＜0.001），住院时间较长（5.5±0.7 vs 24.0±9.8d；p＜0.001），辅助化疗时间也较长（27.2±2.6 vs 65.3±13.4d；p＜0.001）。
讨论
多学科无血医学和手术方案的应用是安全有效的，可降低耶和华见证人晚期上皮性卵巢癌患者术后严重贫血的发生率，并改善手术和肿瘤学结局。需要进一步的大规模前瞻性研究来证实这些数据。
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