围手术期输血对胃癌患者预后的影响

发布时间：2018-06-16 04:02

  本文选题：胃癌 + 围手术期输血　； 参考：《上海交通大学》2015年硕士论文

【摘要】：目的胃癌是排名第四的常见癌症和导致癌症相关死亡的第二大主因。胃癌患者常因急性/慢性出血、肿瘤消耗等因素造成不同程度的贫血,而输血是纠正贫血最主要的治疗方式。长期以来肿瘤患者输血,特别是围手术期输血一直存在争议,多数学者认为可能影响预后,缩短患者生存期。目前有相关研究认为围手术期输血系影响胃癌预后的独立危险因素,但也有持相反意见者。为此,本研究拟通过回顾性研究,分析围手术期输血对胃癌患者预后的影响以阐明两者之联系,从而给临床胃癌患者的治疗提供借鉴。方法入选2008-2009年间在上海交通大学医学院附属瑞金医院胃癌专业组确诊并接受手术治疗的281位胃癌患者,收集并录入临床资料、治疗结果,完成随访后进行回顾性分析。通过统计学方法分析围手术期输血对于胃癌患者预后的影响。结果完成随访病例281例,其中男性183例,女性98例,中位年龄60岁。五年生存率未输血组72.7%,输血组45.8%,两组存在统计学差异,提示围手术期输血胃癌患者总体生存率差于未输血患者。依据术后病理TNM分期分析I期(早期)患者五年生存率,未输血组96.6%,输血组93.8%,两组无统计学差异;II期患者五年生存率未输血组70.7%,输血组58.8%,存在统计学差异;III期患者五年生存率未输血组44.3%,输血组26.0%,存在统计学差异。研究结果提示围手术期输血为II期、III期(进展期)胃癌预后独立危险因素。依据输血时段分为术前输血组、术中输血组和术后输血组,统计各自五年生存率:分别是术前输血组60%,术中输血33.3%,术后输血56.3%;三组中以术中输血组预后最差,存在统计学上差异。根据输血量不同进行分析提示输血量与预后无明显相关性。多因素分析提示TNM分期II期、III期、术前低蛋白、术前低血红蛋白、肿瘤侵及浆膜(T4)、淋巴结转移、肿瘤大小≥5cm,病理低分化类型为胃癌预后的独立危险因素。结论本研究结果显示,围手术期输血为影响进展期胃癌患者预后的独立危险因素,而输血量多寡未显著影响预后。胃癌患者围手术期输血特别是术中输血应慎重且尽可能避免。
[Abstract]:Objective gastric cancer is the fourth leading cause of cancer and cancer-related deaths. Patients with gastric cancer often suffer from various degrees of anemia due to acute / chronic hemorrhage and tumor consumption, and blood transfusion is the main treatment to correct anemia. For a long time, blood transfusion in tumor patients, especially in perioperative period, has been controversial. Most scholars think that it may affect the prognosis and shorten the survival time of patients. At present, some related studies suggest that perioperative blood transfusion is an independent risk factor for the prognosis of gastric cancer, but there are others who hold the opposite view. Therefore, this study aims to analyze the influence of perioperative blood transfusion on the prognosis of patients with gastric cancer by retrospective study, so as to elucidate the relationship between the two and provide reference for clinical treatment of gastric cancer patients. Methods 281 gastric cancer patients who were diagnosed and treated surgically in Ruijin Hospital affiliated to Shanghai Jiaotong University Medical College from 2008 to 2009 were collected and recorded the clinical data and the results were analyzed retrospectively after follow-up. The effect of perioperative blood transfusion on the prognosis of patients with gastric cancer was analyzed statistically. Results 281 cases were followed up, including 183 males and 98 females with a median age of 60 years. The 5-year survival rate was 72.7% in the non-transfusion group and 45.8% in the transfusion group. There was statistical difference between the two groups, which suggested that the overall survival rate of the patients with gastric cancer during perioperative period was worse than that of the patients without blood transfusion. The 5-year survival rate of stage I (early) patients was analyzed by TNM staging. There was no statistical difference in the 5-year survival rate between the two groups. The 5-year survival rate was 70.7 in the non-transfusion group and 58.8 in the transfusion group. There was statistical difference in the 5-year survival rate between the non-transfusion group and the non-transfusion group (44.3%, 26.0%), and there was statistical difference between the two groups. The results suggest that perioperative blood transfusion is an independent prognostic risk factor for stage II stage III (advanced) gastric cancer. According to the period of blood transfusion, the patients were divided into preoperative transfusion group, intraoperative transfusion group and postoperative transfusion group. The 5-year survival rates of each group were as follows: the preoperative transfusion group was 60, the intraoperative transfusion was 33.3, the postoperative blood transfusion was 56.3, the prognosis of the intraoperative transfusion group was the worst. There is a statistical difference. Analysis according to the volume of blood transfusion showed that there was no significant correlation between blood transfusion volume and prognosis. Multivariate analysis indicated that TNM stage II stage III, preoperative low protein, preoperative low hemoglobin, tumor invasion of serous membrane T4, lymph node metastasis, tumor size 鈮，

本文编号：2025191