Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease

BACKGROUND: Preoperative autologous blood donation has been suggested for patients with liver disease who are to undergo liver resection. The aim of this retrospective study was to clarify the risk factors for increased blood loss and the need for blood transfusion during hepatectomy for hepatocellular carcinoma (HCC). METHODS: From January 1996 to December 2000, 206 consecutive patients, 98.5 per cent of whom had underlying liver disease, underwent elective hepatectomy for HCC. RESULTS: Major hepatectomy was performed in 34 patients (16.5 per cent) and minor hepatectomy in 172 patients (83.5 per cent). The mean blood loss was 410 (median 260) ml. Eleven (5.3 per cent) of the 206 patients received blood transfusion during or after the operation. Operation time (P = 0.004) and central venous pressure (CVP) (P = 0.041) were independently correlated with blood loss of more than 1000 ml. Only preoperative haemoglobin level (P = 0.001) was independently correlated with the need for blood transfusion. CONCLUSION: In patients with underlying liver disease, maintaining CVP at a level below 5 cm H2O during parenchymal transection to reduce blood loss is more important than reserving autologous blood before the operation.     

肝癌切除术患者围手术期血脂代谢的变化及其临床意义

目的 分析肝细胞肝癌(HCC)肝切除术患者围手术期血脂的变化及其与前清蛋白、转氨酶变化的关系.方法 选取HCC肝手术患者126例,测定术前及术后1,3,7 d的甘油三酯、胆固醇、前清蛋白、转氨酶水平.结果 HCC患者术前胆固醇降低,与对照组有显著差异(P＜0.01),术后第1,3,7天甘油三酯、胆固醇较术前明显降低(P＜0.01).胆固醇变化与谷丙转氨酶呈负相关(r=-0.231,P＜0.05),与前清蛋白无相关性(r=0.082,P＞0.05).甘油三酯水平与术前清蛋白及谷丙转氨酶水平无相关性(r=0.091,P＞0.05;r=0.086,P＞0.05).结论 HCC患者存在血脂代谢紊乱,术后血脂降低可能与肝功能损害及手术应激有关.     

大肝癌手术切除的风险性分析

目的评价大肝癌手术切除的安全性.方法回顾性分析310例大肝癌手术切除病例.结果本组60.7%(188/310)的患者伴有乙型肝炎病毒感染,66.8%(207/310)伴有肝硬化.癌灶长径平均为(9.4±3.8)cm,肝功能A级占51.0%(158/310),B级36.8%(114/310),C级12.3%(38/310).Pringle法、半肝血流阻断和改良全肝血流阻断术使用率分别为31.6%(98/310)、11.0%(34/310)、2.3%(7/310),阻断时间分别为(17±8)min、(25±9)min和(20±10)min.左外叶切除占17.1%(53/310),左半肝切除11.6%(36/310),右半肝切除占9.0%(28/310),肝段切除占62.3%(193/310).术中失血量、输血量以及手术时间分别为(820±1 151)ml、(966±945)ml和(182±74)min.术后并发症及肝功能衰竭发生率分别为22.3%(69/310)和5.8%(18/310),手术死亡率为2.6%(8/310).单变量分析提示术前AST(P<0.05)、肝功能Child-Pugh 分级(P<0.05)、肝硬化程度(P<0.05)、癌灶长径(P<0.05)、手术时间(P<0.01)和术中失血量(P<0.01)等是术后肝功能衰竭发生的危险因素.多变量Logistic回归分析示手术时间及术中失血量是术后肝功能衰竭发生的独立危险因素(P<0.01,P<0.01).结论大肝癌手术切除是安全的.应控制术中失血和手术时间以降低肝功能衰竭发生率.     

Perioperative exercise for chronic liver injury patients with hepatocellular carcinoma undergoing hepatectomy

Background

The aim of this study was to examine the outcomes of exercise therapy in patients with hepatocellular carcinoma who underwent hepatectomy.

Methods

Fifty-one patients with hepatocellular carcinoma were randomized to diet therapy alone (n = 25) or to exercise in addition to diet therapy (n = 26). Exercise at the anaerobic threshold of each patient was started 1 month preoperatively, resumed from 1 week postoperatively, and continued for 6 months.

Results

Whole body mass and fat mass in the exercise group compared with the diet group were significantly decreased at 6 months postoperatively. Fasting serum insulin and the homeostasis model assessment score were also significantly decreased. At 6 months, anaerobic threshold and peak oxygen consumption were significantly increased, while serum insulin and insulin resistance were significantly improved in a high-frequency exercise subgroup compared with a low-frequency group.

Conclusions

Perioperative exercise therapy for patients with hepatocellular carcinoma with liver dysfunction may improve insulin resistance associated with hepatic impairment and suggests a benefit to the early resumption of daily exercise after hepatectomy.     

术中局部植入氟尿嘧啶缓释剂治疗原发性肝细胞癌

目的 探讨肝癌根治术中植入氟尿嘧啶缓释剂的安全性及其对无瘤生存率和总体生存率的影响.方法 收集2008年1月至2009年1月完成肝癌根治手术的患者59例,按术中有无使用氟尿嘧啶缓释剂分为治疗组(24例)和对照组(35例),两组患者术后均未予其他化疗.检测两组患者术前1天、术后3周的白细胞、肝功能、AFP;术后半年内每月、半年后每3个月复查AFP及影像学,对可疑复发的患者行CT引导下穿刺活检确诊,统计术后6、12、18、24个月的无瘤生存率和总体生存率.结果 术后3周治疗组WBC、ALT、AST、TBIL,与对照组差异无统计学意义(分别t=0.801、-0.854、- 1.948、- 0.503,均P＞0.05).治疗组术前、术后3周、术后6个月AFP为(361.58±431.06) μg/L、(17.02±15.55)μg/L、(43.61±58.03) μg/L,对照组为(495.50±441.63) μg/L、(26.82±60.46) μg/L、(127.48±229.79) μg/L.术后6个月治疗组明显低于对照组(t=-2.065,P＜0.05).治疗组术后6、12、18、24个月的无瘤生存率为95.8％、91.7％、79.2％、75.0％,对照组为94.3％、71.4％、60.0％、48.6％(Log rank检验x2=4.035,P＜0.05);治疗组术后6、12、18、24个月的总体生存率为100％、95.8％、91.7％、83.3％,对照组为100％、94.3％、77.1％、60.0％(Log rank检验x2=3.931,P＜1.05).结论 术中植入氟尿嘧啶缓释剂具有良好的安全性,是降低肝癌复发率、延长患者生存期的有效方法.     

输血对大肝癌切除术后近远期预后的影响

目的研究输血对大肝癌切除术后近期并发症和远期存活率的影响。方法回顾性分析177例大肝癌切除术病例，结合随访分析输血对近期并发症和远期存活率的影响。结果本组大肝癌围手术期输血率为74．6％。近5年输血量及输血率较5年前显著减少（P〈0．01）。不输血组并发症率低于输血组（P〈0．05）。单因素分析显示，年龄、肝门阻断、术中出血量、输血量以及手术时间与术后并发症发生有关。多因素分析显示，年龄、肝门阻断、输血量以及手术时间是决定术后并发症的4个独立的预测指标。本组大肝癌1、3、5年总存活率为67％、44％和34％，1、3、5年无瘤存活率为51％、31％和31％。不输血组和输血组的总存活率以及无瘤存活率无显著差别。结论输血是决定大肝癌切除术后并发症发生的独立危险因素之一，但输血对大肝癌切除术后存活率无显著影响。肝脏外科医生应积极采取各种方法尽可能避免大肝癌切除术围手术期的输血。     

No impact of perioperative blood transfusion on recurrence of hepatocellular carcinoma after hepatectomy

Background  

Although several studies have shown that perioperative blood transfusion is a poor prognostic factor of outcome after hepatectomy for hepatocellular carcinoma (HCC), the impact of perioperative blood transfusion on the prognosis of HCC remains unknown.     

Desmopressin does not decrease blood loss and transfusion requirements in patients undergoing hepatectomy

PURPOSE: To determine the effects of desmopressin on coagulation and blood loss in patients undergoing elective partial hepatectomy. METHODS: A randomized, controlled and double-blind study on 59 patients who received either 0.3 micro g x kg(-1) of desmopressin or an equal volume of normal saline (control) infused intravenously over 20 min after induction of general anesthesia. RESULTS: There was an increase in plasma levels of factors VIII and von Willebrand after the infusion of study drug in both groups (P < 0.001). The activated partial thromboplastin time was shortened in Group D whereas prothrombin time was prolonged in Group C; (P = 0.02). A large range of intraoperative blood loss (400-7128 mL) was observed, with no significant differences between groups. There were no changes in plasma electrolyte levels or osmolality. Transfusion requirements were similar in both groups. CONCLUSION: Desmopressin did not reduce intraoperative blood loss or transfusion requirements during hepatectomy despite raising clotting factor levels and improving tests of hemostasis.     

中性粒细胞-淋巴细胞比值预测肝细胞癌患者TACE术后预后

目的探讨中性粒细胞-淋巴细胞比值(NLR)预测肝细胞癌(HCC)患者TACE后预后的价值。方法回顾性分析接受TACE治疗的HCC患者77例,计算术前、术后NLR,分析NLR与临床病理特征和预后的关系。结果以NLR=4为界,术前高NLR组(NLR≥4)和低NLR组(NLR<4)患者临床基线资料的差异均无统计学意义(P均>0.05);术前高NLR组患者中位总生存期短于低NLR组,分别为7.8个月和16.0个月(P=0.028)。多因素分析显示术前NLR≥4(P=0.01)、肿瘤≥5cm(P=0.01)是影响预后的独立危险因素。结论 NLR是预测HCC患者TACE术后预后的指标之一;术前NLR≥4者生存期较短。     

Recent trends in hepatectomy for elderly patients with hepatocellular carcinoma

Purpose

The incidence of hepatocellular carcinoma (HCC) in the elderly population has recently been increasing. In this study, we focused on a recent 10-year survey, and compared the clinicopathological features and postoperative outcomes of HCC in elderly (≥75 years of age) and younger patients (<75 years of age).

Methods

A total of 255 patients who underwent hepatectomy for HCC from 2001 to 2010 at Wakayama Medical University Hospital were reviewed. The clinical characteristics were compared between the elderly and younger patients. The risk factors for postoperative complications and prognostic factors were identified using the multivariate analyses.

Results

A total of 66 patients were classified as elderly patients. The incidence of HCC without viral liver disorders was significantly high in the elderly group than in the younger group. The independent risk factors [odds (95 % confidence intervals)] for postoperative complications were an ASA score of 3 [2.57 (1.20–5.49)] and the length of the operation [1.41 (1.09–1.81)]. The survival was similar between the two groups, and the only independent prognostic factor for survival in the elderly patients was vessel invasion.

Conclusions

HCC derived from non-viral liver disorders was dominant in the elderly patients. Aging itself was not a risk factor for postoperative complications or the survival outcome.     

影响肝细胞肝癌手术切除预后因素的COX模型分析

目的 对影响肝细胞肝癌手术切除预后的因素进行多因素分析。方法 1986－1996年经手术切除的145例肝癌患者,随访至1999年底。单因素分析采用Kaplain-Meier Log-rank时序检验,多因素采用COX比例风险模型。结果 手术后1、3、5、7、10、12年生存期分别为75．0％、44．4％、29．5％、23．5％、21．2％、16．9％;单因素分析影响预后因素为发现方式、肝癌体积、有否门静脉癌栓、卫星结节及肝癌结节数、UICC分期、手术切缘、有否复发及复发后治疗方式、是否根治性切除;多因素分析得出和预后有关的因素为发现方式、UICC分期、手术切缘、有否复发及复发后治疗方式,是否根治性切除。结论 肝癌的预后取决于早期诊断及治疗方式;UICC分期与预后相关,且与卫星结节、结节数、门静脉癌栓相关。1cm以上的手术切缘,可明显提高切除疗效。     

Autologous blood transfusion in urology

In a total of 67 urological patients (24 transurethral resections of the prostate, 30 transvesical resections of the prostate and 13 radical prostatectomies) the blood lost during the operation was collected by using the Haemonetics cell saver, washed and cleaned of cells, haemoglobin and plasma haemoglobin and retransfused to the patients in the form of erythrocyte concentrate. When patients lose a large volume of blood, the lost plasma volume and the lost clotting factors must be substituted: in addition to electrolyte and colloidal solutions we use autologous fresh frozen plasma (FFP). Preoperatively we usually obtain FFP from the patient by plasmapheresis. All patients have tolerated the preoperative plasmapheresis very well and also the subsequent retransfusion of the intraoperatively saved autologous blood. Only 1 patient (who unexpectedly suffered a postoperative haemorrhage) received homologous blood; in other cases no homologous transfusion became necessary despite blood losses of up to 4500 ml.     

Laparoscopic hepatectomy for hepatocellular carcinoma in cirrhotic patients

Introduction  We have used laparoscopic hepatectomy as a surgical treatment for HCC in patients with cirrhosis. We describe the indications, evaluate invasiveness and analyze the outcomes of laparoscopic hepatectomy. Methods and Results  With respect to operative method, laparoscopic hepatectomy involving either partial hepatectomy or left lateral sectionectomy is a less invasive procedure in patients with cirrhosis than conventional hepatectomy. Among our laparoscopic hepatectomy cases, operative time was shorter and bleeding was less in recent, as compared to earlier, cases. Furthermore, laparoscopic hepatectomy was less invasive than conventional hepatectomy, as determined by the E-PASS scoring system. Patients also recovered more quickly, which resulted in shorter hospital stays even for patients with cirrhosis. Both the 5-year survival rate and the rate of survival without recurrence of HCC were nearly identical to those of open conventional hepatectomy. Conclusion  These findings indicate that laparoscopic hepatectomy avoids the disadvantages of standard hepatectomy for HCC in properly selected patients with cirrhosis and that its minimal invasiveness improves patients’ quality of life.     

Clinical experience of autologous blood transfusion in patients undergoing nephrectomy with renal cell carcinoma]

We studied the possibility of performing radical nephrectomy with only predeposit autologous blood transfusion in the treatment of patients with renal cell carcinoma. A total of 15 patients who ranged in age from 32 to 69 years and had a hemoglobin concentration of over 12 g/dl on admission underwent radical nephrectomy with preoperative autologous blood donation. Five patients did not need transfusions. Seven patients were transfused only autologous blood. The other 3 required some homologous blood in addition to their own banked blood. In our series, patients were able to donate 600 ml of blood during the last week before surgery and their hemoglobin concentration did not decrease by over 2 g/dl except in the case of two patients with advanced disease. Therefore, it was concluded that an adequate autologous blood volume for nephrectomy was 600 ml and that 80% of renal cell carcinoma surgery could be performed without homologous blood transfusion. For patients requiring resection of renal cell carcinoma, autologous transfusion is recommended as safe and convenient.     

术前血小板与淋巴细胞比值对肝癌切除术后患者预后价值的Meta分析

背景与目的:肝癌是最常见的恶性肿瘤之一,一直以来影响着人类健康.肝切除术是肝癌首选的治疗方式,但术后复发率高、生存期短严重影响手术疗效.随着肿瘤相关炎症的研究不断深入,包括血小板与淋巴细胞比值(PLR)在内的一系列全身炎症指标被逐步提出,并被认为是可用于预测恶性肿瘤患者预后的标志物.近年来,研究发现术前PLR可作为预测...     

血清前白蛋白与肝细胞癌患者肝切除术预后的相关性研究

目的研究肝切除术前血清前白蛋白水平与原发性肝细胞癌(HCC)患者肝切除术预后的相关性。方法回顾性分析2007年8月到2016年10月在广西医科大学附属肿瘤医院接受肝切除术治疗的HCC患者临床资料。分别以前白蛋白200 mg/L和采用最大选择秩统计量法预测的前白蛋白为界值进行分组,并分别分析术前血清前白蛋白水平与临床病理特征的相关性。采用Kaplan-Meier法计算不同界值水平患者的累积生存率;采用C。x比例回归模型分析血清前白蛋白与HCC患者肝切除术预后的关系并进行校正;以肝硬化、甲胎蛋白水平及巴塞罗那临床肝癌分期为分层变量进行分层分析并分析其与血清前白蛋白的交互作用。结果共纳入2022例患者,其中男性1739例,女性283例,年龄(49.5±11.2)岁冲位随访37.4个月。最大选择秩统计量法预测的前白蛋白最佳界值为166 mg/L。无论以前白蛋白200 mg/L或前白蛋白166 mg/L为界值,多因素分析显示术前血清前白蛋白水平是患者预后独立的危险因素(P<0.05)。术前血清前白蛋白>200 mg/L(>166 mg/L)患者的预后显著优于前白蛋白≤200 mg/L(≤166 mg/L)的患者,差异均具有统计学意义(均P<0-05)。调整混杂因素后,结果表明前白蛋白水平与HCC患者预后有关联[界值200 mg/L:HR(95%CI)为1.59(1.35〜1.86),界值166 mg/L:HR(95%CZ)为1.69(1.44^1.98),均P<0.05]。分层分析结果表明前白蛋白水平与HCC患者预后的关系较为稳健。结论术前血清前白蛋白是HCC患者预后独立危险因素,对HCC患者的预后有一定预测价值。