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World J Surg：术中出血量影响食管癌患者生存

2012-08-27 胡杨 陈龙奇 中国医学论坛报

术中出血失血食管癌
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  　　肿瘤患者术后预后问题一直备受关注，肿瘤分期、手术彻底性和手术前后辅助治疗等是公认的影响术后预后的因素，而术中出血量对患者预后是否存在影响目前尚无定论。《世界外科杂志》[World J Surg 2012， 36（4）: 844]发表的一项研究提示，在排除其他因素干扰后，术中出血量的大小对食管癌切除术后患者生存有显著影响，中位术中

术中出血量影响食管癌患者生存
 

　　肿瘤患者术后预后问题一直备受关注，肿瘤分期、手术彻底性和手术前后辅助治疗等是公认的影响术后预后的因素，而术中出血量对患者预后是否存在影响目前尚无定论。《世界外科杂志》[World J Surg 2012， 36（4）: 844]发表的一项研究提示，在排除其他因素干扰后，术中出血量的大小对食管癌切除术后患者生存有显著影响，中位术中出血量≥510 ml者的生存显著劣于出血量＜510 ml者（P=0.00295）。

　　诸多研究表明，大量失血将导致患者消化道局部或全身的低灌注现象，可能造成其全身炎症反应的增强或免疫功能的损伤，促进术后残余肿瘤细胞的生长，最终影响患者预后。

　　从另一角度来说，术中失血量其实是手术创伤的重要反映，手术彻底性必然与手术创伤存在明显的线性关系。该研究提示，不应过度讲究肿瘤切除彻底性而忽略手术本身创伤对患者预后的影响。因此对不同分期患者，不能使用相同手术原则来对待。对于较早期患者，为达成所谓的“彻底切除”而盲目扩大手术范围的做法值得商榷。

　　这些研究也为目前“席卷”世界的微创手术带来了有利的消息。之前不断有个别报道提到，微创手术疗效要优于开放手术，但其可靠性常受到质疑。这些研究提示，手术创伤确实可能对肿瘤预后造成显著影响，这从另一角度对之前报道提出了有力的佐证。

链接：
Komatsu Y, Orita H, Sakurada M, Maekawa H, Hoppo T, Sato K.Intraoperative blood transfusion contributes to decreased long-term survival of patients with esophageal cancer.World J Surg. 2012 Apr;36(4):844-50.


    

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    2013-07-31 肉我只吃一口

    #食管癌患者#

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    2013-01-18 limedical1986

    #出血量#

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    2012-09-12 tastas

    #患者生存#

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    2012-08-29 zhouqu_8

    #食管#

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