Haberkern C M, Neumayr L D, Orringer E P, Earles A N, Robertson S M, Black D, Abboud M R, Koshy M, Idowu O, Vichinsky E P
Department of Anesthesiology, University of Washington, Seattle, USA.
Blood. 1997 Mar 1;89(5):1533-42.
Cholecystectomy is the most common surgical procedure performed in sickle cell anemia (SCA) patients. We investigated the effects of transfusion and surgical method on perioperative outcome. A total of 364 patients underwent cholecystectomy: group 1 (randomized to aggressive transfusion) 110 patients; group 2 (randomized to conservative transfusion) 120 patients; group 3 (nonrandomized nontransfusion) 37 patients; and group 4 (nonrandomized transfusion) 97 patients. Patients were similar except group 3 patients were more likely to be female, over 20 years old, smokers, and more healthy by American Society of Anesthesiologists (ASA) physical status score. Total complication rate was 39%: sickle cell events 19%; intraoperative or recovery room events 11%; transfusion complications 10%; postoperative surgical events 4%; and death 1%. Group 3 patients had the highest incidence of sickle cell events (32%). Open cholecystectomies were performed in 58% and laparoscopic in 42%. Laparoscopic patients were younger and more healthy by ASA score. Laparoscopic patients had longer anesthesia time (3.2 v 2.9 hours), but shorter hospitalization time (6.4 days v 9.8). Complications were similar between these two groups. We conclude that SCA patients undergoing cholecystectomy have a high perioperative morbidity, and the incidence of sickle cell events may be higher in patients not preoperatively transfused. We recommend a conservative preoperative transfusion regimen, and we encourage the use of the laparoscopic technique for SCA patients undergoing elective cholecystectomy.
胆囊切除术是镰状细胞贫血（SCA）患者最常进行的外科手术。我们研究了输血和手术方法对围手术期结局的影响。共有364例患者接受了胆囊切除术：第1组（随机接受积极输血）110例患者；第2组（随机接受保守输血）120例患者；第3组（非随机非输血）37例患者；第4组（非随机输血）97例患者。除第3组患者更可能为女性、年龄超过20岁、吸烟者且根据美国麻醉医师协会（ASA）身体状况评分更健康外，各患者组情况相似。总并发症发生率为39%：镰状细胞事件占19%；术中或恢复室事件占11%；输血并发症占10%；术后手术事件占4%；死亡占1%。第3组患者镰状细胞事件发生率最高（32%）。58%的患者接受了开腹胆囊切除术，42%接受了腹腔镜胆囊切除术。腹腔镜手术患者更年轻，根据ASA评分更健康。腹腔镜手术患者麻醉时间更长（3.2小时对2.9小时），但住院时间更短（6.4天对9.8天）。两组之间并发症情况相似。我们得出结论，接受胆囊切除术的SCA患者围手术期发病率较高，术前未输血患者的镰状细胞事件发生率可能更高。我们建议采用保守的术前输血方案，并鼓励对接受择期胆囊切除术的SCA患者使用腹腔镜技术。
