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。

Effects of blood transfusion on short-and long-term prognosis of patients following hepatectomy for large hepatocellular carcinoma

Objective To investigate the effects of blood transfusion on short- and long-term prognosis of patients following hepatectomy for large hepatocellular carcinoma (HCC). Methods The clinical data of 177 patients with large HCC treated in our hospital were retrospectively analyzed. Results The perioperative blood transfusion rate was 74. 6%. The morbidity was lower in the no-blood transfusion group than in the blood transfusion group. Univariate analysis showed that the age, portal clamping, intraoperative blood loss, blood transfusion and operative duration were associated with postoperative complications. Multivariate stepwise regression analysis revealed that the age, portal clamping, blood transfusion and operative duration were the 4 independent risk factors of the morbidity of postoperative complications. The 1-, 3- and 5-year overall survival rates were 67%, 44% and 34% while the 1-, 3- and 5-year cancer-free survival rates 51%, 31% and 31%, respectively. There were no significant differences in the overall and cancer-free survival rates between the no-blood transfusion group and blood transfusion group. Conclusions Perioperative blood transfusion is a risk factor for the morbidity of complications after hepatectomy for large HCC. Every effort should be made to avoid blood transfusion to improve the outcome of hepatectomy for large HCC.