Shirasu Daiki, Tsuchiya Masahiko, Oomae Noriaki, Shirasaka Wataru, Iino Tatsuhiko, Hirano Daisuke, Satani Makoto
Kishiwada Tokushukai Hospital, Emergency and Critical Care Center, 4-27-1 Kamori-Cho, Kishiwada, Osaka, 596-0042, Japan.
Department of Anesthesiology, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada, Osaka, 596-0042, Japan.
JA Clin Rep. 2023 Jun 22;9(1):38. doi: 10.1186/s40981-023-00631-x.
The efficacy of tranexamic acid in elective major invasive abdominal surgeries has not yet been established. We investigated the effect of tranexamic acid administration on intraoperative blood loss during peritoneal resection of pseudomucinoma and cancerous peritoneal dissemination.
Patients aged ≥ 20 years old who underwent peritoneal resection for pseudomucinoma or cancerous peritoneal dissemination at the Kishiwada Tokushukai Hospital were included in this single-center retrospective observational study. The tranexamic acid group received 1000 mg of tranexamic acid at the start of the operation, while the control group received the same intraoperative management as the tranexamic acid group, except for the tranexamic acid administration. The primary endpoint was intraoperative blood loss, and a multivariate analysis of the contributing factors was performed.
The median volume of intraoperative blood loss was 1372 [interquartile range, 842 - 1877] mL and 907 [516 - 1537] mL in the control and tranexamic acid groups, respectively (p < 0.01). The total volume of blood transfusion during the operation was 2040 [1480 - 2380] mL and 1560 [1000 - 2120] mL in the control and tranexamic acid groups, respectively (p = 0.02). Postoperative blood test results revealed D-dimer values of 7.5 [4.1 - 10.7] µg/mL and 1.8 [1.0 - 3.3] µg/mL in the control and tranexamic acid groups, respectively (p < 0.01). Multivariate analysis showed that tranexamic acid administration was significantly associated with decreased intraoperative blood loss (p = 0.02).
Tranexamic acid administration may be useful in reducing intraoperative blood loss and blood transfusion volume during highly-invasive surgeries such as peritoneal resection of pseudomucinoma and cancerous peritoneal dissemination.
氨甲环酸在择期腹部大手术中的疗效尚未确定。我们研究了氨甲环酸给药对黏液性囊腺瘤和癌性腹膜播散性疾病腹膜切除术中失血的影响。
本单中心回顾性观察研究纳入了在岸和田德洲会医院接受黏液性囊腺瘤或癌性腹膜播散性疾病腹膜切除术的年龄≥20岁的患者。氨甲环酸组在手术开始时接受1000mg氨甲环酸，而对照组除未给予氨甲环酸外，接受与氨甲环酸组相同的术中管理。主要终点是术中失血，并对相关因素进行多变量分析。
对照组和氨甲环酸组术中失血量中位数分别为1372[四分位间距，842 - 1877]mL和907[516 - 1537]mL（p < 0.01）。对照组和氨甲环酸组手术期间输血总量分别为2040[1480 - 2380]mL和1560[1000 - 2120]mL（p = 0.02）。术后血液检查结果显示，对照组和氨甲环酸组D - 二聚体值分别为7.5[4.1 - 10.7]μg/mL和1.8[1.0 - 3.3]μg/mL（p < 0.01）。多变量分析显示，氨甲环酸给药与术中失血量减少显著相关（p = 0.02）。
在黏液性囊腺瘤腹膜切除术和癌性腹膜播散性疾病等高侵袭性手术中，氨甲环酸给药可能有助于减少术中失血量和输血量。
