Park K I, Kojima O, Tomoyoshi T
Department of Urology, Shiga University of Medical Science, Seta, Otsu, Japan.
J Urol. 1997 May;157(5):1777-80.
Intraoperative autotransfusion in urological operations has the risks of reinfusing urine constituents, bacteria and cancer cells. We assessed the efficacy of intraoperative autotransfusion and leukocyte removal filters to separate red blood cells from these constituents.
Concentrated red blood cells were mixed with urine, bacteria (Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae) and tumor cells (KK47 and ACHN), and processed with the intraoperative autotransfusion device. Biochemical analyses of erythrocytes collected in reinfusion bags (collected erythrocyte solution) from the mixtures of concentrated red blood cells and urine (mixture 1), and cultures of collected erythrocyte solution from the mixtures of concentrated red blood cells and bacteria (mixture 2) were performed. Cytology was done on collected erythrocyte solution from the mixtures of concentrated red blood cells and tumor cells (mixture 3) and filtrates were passed through leukocyte removal filters.
Biochemical analyses of collected erythrocyte solution from mixture 1 indicated complete removal of urine constituents, while cultures from mixture 2 yielded bacterial growth. Tumor cells from both cell lines were found in the collected erythrocyte solution from mixture 3 although tumor cells were not found in filtrates through leukocyte removal filters.
Our results suggest that intraoperative autotransfusion is safe for urological operations in which bacteria and tumor cells are not present in the operative field. Our data also indicate that intraoperative autotransfusion may be safe for urological cancer operations if it is combined with leukocyte removal filters to prevent unexpected reinfusion of tumor cells.
泌尿外科手术中的术中自体输血存在重新输入尿液成分、细菌和癌细胞的风险。我们评估了术中自体输血和白细胞去除滤器从这些成分中分离红细胞的效果。
将浓缩红细胞与尿液、细菌（大肠杆菌、铜绿假单胞菌和肺炎克雷伯菌）和肿瘤细胞（KK47和ACHN）混合，并用术中自体输血装置进行处理。对从浓缩红细胞与尿液的混合物（混合物1）中收集于回输袋中的红细胞（收集的红细胞溶液）进行生化分析，对从浓缩红细胞与细菌的混合物（混合物2）中收集的红细胞溶液进行培养。对从浓缩红细胞与肿瘤细胞的混合物（混合物3）中收集的红细胞溶液进行细胞学检查，并使滤液通过白细胞去除滤器。
对混合物1中收集的红细胞溶液的生化分析表明尿液成分已完全去除，而混合物2的培养物中有细菌生长。在混合物3中收集的红细胞溶液中发现了两种细胞系的肿瘤细胞，尽管通过白细胞去除滤器的滤液中未发现肿瘤细胞。
我们的结果表明，术中自体输血对于手术区域不存在细菌和肿瘤细胞的泌尿外科手术是安全 的。我们的数据还表明，如果术中自体输血与白细胞去除滤器联合使用以防止意外回输肿瘤细胞，那么对于泌尿外科癌症手术可能也是安全的。
