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目的探讨影响胃癌术中输血量的相关因素及输血量对预后的影响。方法从1994年8月至2010年12月,我院接受根治性及姑息性切除术的胃癌患者1518例,依术中输血量(ml)由低至高分为5组(A~E),回顾性分析不同临床病理参数及治疗方式对输血量的影响,以及输血量对预后的影响。结果不同性别、年龄、肿瘤Borrmann分型、WHO组织分型、分化程度间患者术中平均输血量无显著差异(P>0.05)。1994年~2010年,以5年为间隔,输血量呈显著下降趋势(P<0.01)。患者术中平均输血量与肿瘤直径、浸润深度、淋巴结转移度、腹膜种植、肝转移、手术时间、手术方式(根治或姑息切除)、根治程度、胃切除方式、联合脏器切除率、淋巴结阳性数显著相关(P<0.01)。姑息性切除患者的平均输血量为(506.1±517.8)ml,显著高于根治性切除患者的(359.0±498.3)ml(P<0.01)。联合脏器切除患者的平均输血量为(607.3±669.4)ml,显著高于无联合脏器切除患者的(275.7±369.8)ml(P<0.01)。A~E组患者的中位生存期分别为76.4、38.0、31.0、22.3、10.3个月,生存期随输血量增多显著下降(P<0.01)。多因素回归分析显示肿瘤浸润深度、淋巴结转移度、远处转移、Bormann分型、WHO组织分型、根治手术、术中输血是胃癌患者的独立预后因素。结论术中输血量与肿瘤TNM分期及手术方式、根治程度、手术时间相关,输血量为影响预后的独立因素。减少术中输血有益于根治术胃癌患者的预后。
Objective To investigate the factors influencing intraoperative blood transfusion in gastric cancer and the influence of transfusion volume on prognosis. Methods From August 1994 to December 2010, 1518 cases of gastric cancer undergoing radical and palliative resection in our hospital were divided into 5 groups (A ~ E) according to the blood transfusion (ml) To analyze the influence of different clinicopathological parameters and treatment methods on blood transfusion and the influence of blood transfusion on prognosis. Results There was no significant difference in mean intraoperative blood transfusion between different sex, age, tumor Borrmann classification, WHO histological type and differentiation degree (P> 0.05). From 1994 to 2010, blood transfusion showed a significant decrease (P <0.01) at 5-year intervals. The average intraoperative blood transfusion and tumor diameter, depth of invasion, lymph node metastasis, peritoneal planting, liver metastasis, operation time, operation mode (radical or palliative excision), radical, gastrectomy, joint resection rate, lymph node positive Number of significant correlation (P <0.01). The average volume of blood transfusion in patients who underwent palliative resection was (506.1 ± 517.8) ml, significantly higher than that of patients who underwent radical resection (359.0 ± 498.3) ml (P <0.01). The mean blood transfusion in patients with combined organ resection was (607.3 ± 669.4) ml, which was significantly higher than that in patients without combined organ resection (275.7 ± 369.8) ml (P <0.01). The median survival of patients in groups A to E were 76.4, 38.0, 31.0, 22.3 and 10.3 months, respectively, and the survival time decreased significantly with the increase of blood transfusion (P <0.01). Multivariate regression analysis showed that the depth of tumor invasion, lymph node metastasis, distant metastasis, Bormann classification, WHO tissue typing, radical surgery, intraoperative blood transfusion is an independent prognostic factor in patients with gastric cancer. Conclusions Intraoperative blood transfusion is related to tumor TNM stage, operation method, cure rate and operative time, and blood transfusion is an independent factor affecting prognosis. Reduce intraoperative blood transfusion is beneficial to the prognosis of patients with radical surgery of gastric cancer.