术中出血对结肠癌根治术后肿瘤腹膜复发及预后的影响

郭卫平，魏波，区广生，郑峰，陈图锋，黄江龙，刘建培，卫洪波

郭卫平、魏波、区广生、郑峰、陈图锋、黄江龙、刘建培、卫洪波，广州 中山大学附属第三医院胃肠外科，510630

摘要:目的　探讨术中出血与Dukes B、C期结肠癌患者根治术后腹膜复发及预后的关系。方法　2002年1月至2005年12月收治行根治性手术的Dukes B、C期结肠癌患者178例，收集术中出血量、术后化疗、淋巴结转移、围手术期输血、术后肿瘤复发情况及生存时间等资料，观察术中出血量对术后肿瘤复发及预后的影响。结果　腹膜复发组出血量高于无腹膜复发组[(331±185)ml vs.(193±128)ml，P<0.05]；在围手术期未输血组和淋巴结存在转移组中，腹膜复发的患者术中出血量分别为(221±206)ml、(255±180)ml，高于同组中无腹膜复发者(115±109)ml、(156±149)ml(P<0.05)。多因素Logistic回归分析：淋巴结转移和术中出血等因素与术后腹膜复发存在相关性(P<0.05)；利用Kaplan-Meier生存分析，术中出血量≤200 ml组的生存时间高于出血量＞200 ml组，差异具有统计学意义(χ2＝17.746，P<0.01)。结论　术中出血量可作为Dukes B、C期结肠癌术后腹膜复发的独立预测指标之一，可通过影响术后肿瘤腹膜复发率来干预患者的预后。

关键词:结肠肿瘤；　肿瘤转移；　根治性手术；　术中出血；　腹膜复发

上海市松江区科学技术攻关项目(08SJGG40)

Clinical study of the impact of intraoperative blood loss on peritoneal recurrence and prognosis of patients with colon cancer after radical resection

GUO Wei-ping，WEI Bo，OU Guang-sheng，ZHENG Feng， CHEN Tu-feng， HUANG Jiang-long， LIU Jian-pei， WEI Hong-bo.

Department of Gastrointestinal Surgery， Third Affiliated Hospital of Sun Yat-sen University， Guangzhou 510630， China

Abstract:Objective　To investigate the impact of intraoperative blood loss on peritoneal recurrence and prognosis of patients with colon cancer (Dukes B， C) after radical resection. Methods　Consecutive patients (n＝178) (Jan.2002～Dec.2005)with colon cancer (Dukes B， C) after radical resection were assessed. Intraoperative blood loss， postoperative chemotherapy， lymph node metastasis， perioperative blood transfusion， postoperative tumor recurrence and survival time， et al. were collected to observe the effect of intraoperative blood loss on recurrence and prognosis of patients. Results　The amount 331 ml±185 ml of intraoperative blood loss in group with Peritoneal recurrence is higher than group without Peritoneal recurrence 193 ml±128 ml (P<0.05). The amount of intraoperative blood loss of patients with peritoneal recurrence in no perioperative blood transfusion group and lymph node recurrence group are 221 ml±206 ml and 255 ml±180 ml， higher than the same group without peritoneal recurrence 115 ml±109 ml and 156 ml±149 ml respectively(P<0.05). Multivariate logistics regression analysis， lymph node metastasis and intraoperative blood loss were significantly correlated with peritoneal recurrence after radical resection of colon cancer (Dukes B， C) (P<0.05). Kaplan-Meier survival analysis， the survival time of amount of ≤200 ml blood loss group is higher than ＞200 ml blood loss group(χ2＝17.746， P<0.01).Conclusions　Intraoperative blood loss is one of independent predictors of peritoneal recurrence after radical resection of colon neoplasm (Dukes B， C)， and influence the prognosis of patients through this way.

Keywords:Colonic neoplasms；　Neoplasm metastasis；　Radical resection；　Intraoperative blood loss；　Peritoneal recurrence