术中失血量对胃癌根治术后腹膜复发的预测价值

目的 讨论术中失血量与进展期胃癌根治术后复发率及预后的关系.方法 自2003年1月至2005年12月收治行根治性手术的进展期胃癌患者157例,收集术中失血量、肿瘤浸润深度(T期)、术后化疗、淋巴结转移情况、围手术期输血、术后肿瘤复发情况及生存时间等资料,观察术中失血量对术后肿瘤复发及生存时间的影响.结果 腹膜复发组术中失血量(517±287)ml高于无腹膜复发组(372±253)ml(P＜0.05);T3-4组、围手术期输血组、术后未行化疗组和淋巴结未见转移组术后出现腹膜复发患者术中失血量分别为(522±270)ml、(539±331)ml、(516±322)ml、(513±343)ml,显著高于同组中未出现腹膜复发者[(371±276)ml、(347±248)ml、(290±211)ml、(353±249)ml](P＜0.05).多因素logistics回归分析:进展期胃癌患者淋巴结转移、术中出血和术后化疗情况与根治术后腹膜复发相关(P＜0.05);术中失血量≤400 ml组的生存时间长于术中失血量＞400ml组,两者相比差异具有统计学意义(P＜0.05).结论 术中失血量是进展期胃癌根治术后腹膜复发的重要预测指标之一.

Intraoperative blood loss as a predictor of peritoneal recurrence after radical resection of gastric carcinoma

Objective To investigate the relationship between intraoperative blood loss and postoperative peritoneal tumor recurrence and prognosis in gastric cancer patients undergoing radical resection.Methods From Jan 2003 to Dec 2005,consecutively admitted 157 advanced gastric carcinoma patients undergoing radical gastrectomy were enrolled for this study.Intraoporative blood loss,tumor invasion depth (T phase),and postoperative chemotherapy,lymph node metastasis,perioperative blood transfusion,postoperative tumor recurrence and survival time were collected for the evaluation of the effect of intraoperative blood loss on postoperative tumor recurrence and the prognosis.Results The amount(517 ±287) ml of intraoperative blood loss in group with peritoneal recurrence was higher than that without peritoneal recurrence (372 ± 253) ml(P ＜ 0.05).The amount of intraoperative blood loss in patients with peritoneal recurrence in T3-4 group,perioperative blood transfusion group,no chemotherapy group and no lymph node metastasis were respectively (522±270) ml,(539±331) ml,(516±322) ml and (513±343) ml,which was higher than that within the same group without peritoneal recurrence (371±276) ml,(347 ±248) ml,(290± 211) ml and (353± 249) ml,respectively (P ＜ 0.05).Multivariate logistics regression analysis revealed that lymph node metastasis,intraoperative blood loss and postoperative chemotherapy were significantly correlated with peritoneal recurrence (P ＜ 0.05).Kaplan-Meier survival analysis showed that survival in patients with an intraoperative ≤400 ml blood loss was significantly longer than that of ＞ 400ml blood loss (P ＜ 0.05).Conclusion Intraoperative blood loss is an important predictor of peritoneal tumor recurrence in patients of advanced gastric cancer after radical gastreetomy.