术中回收式自体输血对颈动脉体瘤切除术后肿瘤预后的影响

doi:10.19723/j.issn.1671-167X.2025.02.008

摘要/Abstract

摘要：

目的: 探讨术中回收式自体输血对颈动脉体瘤切除术后肿瘤局部复发和远期转移的影响。方法: 选择2009年8月至2020年12月在北京大学人民医院血管外科择期行颈动脉体瘤切除术的患者共61例进行回顾性分析, 其中使用术中回收式自体输血者14例, 未使用者47例。收集患者的一般资料、手术情况以及术后随访结果, 分析比较术中自体输血对颈动脉体瘤切除术后患者肿瘤预后的影响。结果: 自体输血组Shamblin Ⅲ型占比85.7%, 显著高于非自体输血组的31.9%(P=0.003)。14例自体输血的患者中, 8例(57%)需同时使用异体血; 而47例非自体输血患者, 6例(13%)需要使用异体血输血, 自体输血组同时使用异体血的比例更高(P =0.002)。术后30 d内神经损伤发生率29.5%, 组间差异无统计学意义。没有发生早期死亡病例。平均随访(76±37)个月, 局部复发1例, 发生于非自体输血组。没有远处转移, 没有肿瘤相关死亡。估计5年总体生存率96.4%, 10年总体生存率83.8%。两组之间总体生存率差异无统计学意义(P =0.506)。结论: 使用术中回收式自体输血不会增加颈动脉体瘤切除术后局部复发和远处转移的风险。

关键词: 自体输血, 术中血液回收, 颈动脉体瘤, 预后

Abstract:

Objective: To investigate the effect of intraoperative blood salvage autotransfusion on local recurrence and long-term metastasis of patients after carotid body tumor resection. Methods: We retrospectively reviewed a consecutive series of 61 patients undergoing elective carotid body tumor resection from August 2009 to December 2020. Among them, 14 received intraoperative blood salvage autotransfusion (autotrasfusion group) and 47 did not (non-autotransfusion). Data of general information, surgical status and postoperative follow-up results were collected. Results: The proportion of Shamblin Ⅲ in the autotransfusion group was 85.7%, which was significantly higher than 31.9% in the non-autotransfusion group (P=0.003). The average operation time of the 14 patients in the autotransfusion group was (264±84) min, intraoperative blood loss was 1 200 (700, 2 700) mL, and autologous blood transfusion was 500 (250, 700) mL. Of these, 8 patients (57%) required concomitant allogeneic blood with 400 (260, 400) mL of allogeneic blood. The average operation time of the 47 patients in the non-autotransfusion group was (153±75) min, and the intraoperative blood loss was 300 (100, 400) mL. Of these, 6 (13%) required allogeneic blood transfusion, and 520 (400, 520) mL of allogeneic blood was used. Compared with the non-autotransfusion group, the average operation time in the autologous blood transfusion group was significantly longer (P < 0.001), and the intraoperative blood transfusion volume was larger (P=0.007). Of the 14 patients undergoing autotransfusion, 8 (57%) needed allogeneic blood at the same time; while in the 47 non-autologous transfusion patients, 6 (13%) needed allogeneic blood transfusion. The proportion of autotransfusion group using allogeneic blood at the same time was even higher (P=0.002). The incidence of nerve injury within 30 days after surgery was 29.5%, and there was no significant difference between the two groups. No early deaths occurred. The average follow-up was (76±37) months. One case of local recurrence occurred in the non-autotransfusion group. There was no distant metastasis. There were no tumor-related deaths. The estimated 5-year and 10-year overall survival rates were 96.4% and 83.8%, respectively. There was no significant difference in overall survival between the two groups (P=0.506). Conclusion: The use of intraoperative blood salvage autotransfusion increased no risk of local recurrence and distant metastasis in patients with carotid body tumor, which is safe and effective in carotid body tumor resection.

Key words: Blood transfusion, autologous, Operative blood salvage, Carotid body tumor, Prognosis

中图分类号:

R457.1

李伟浩, 李晶, 张学民, 李伟, 李清乐, 张小明. 术中回收式自体输血对颈动脉体瘤切除术后肿瘤预后的影响[J]. 北京大学学报（医学版）, 2025, 57(2): 272-276.

Weihao LI, Jing LI, Xuemin ZHANG, Wei LI, Qingle LI, Xiaoming ZHANG. Effect of intraoperative blood salvage autotransfusion on the prognosis of patients after carotid body tumor resection[J]. Journal of Peking University (Health Sciences), 2025, 57(2): 272-276.

图/表 2

表1

图1

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Perioperative test results		Patients with intraoperative blood salvage (n=14)	Patients without intraoperative blood salvage (n=47)	P
White blood cell/(×10⁹/L)	Pre-operative	6.4±1.6	6.0±1.2	0.236
White blood cell/(×10⁹/L)	Post-operative	10.4±3.3	10.3±3.1	0.896
Hemoglobin/(g/L)	Pre-operative	126±21	130±18	0.489
Hemoglobin/(g/L)	Post-operative	122±16	119±16	0.457
Platelet/(×10⁹/L)	Pre-operative	256±66	239±53	0.335
Platelet/(×10⁹/L)	Post-operative	222±79	218±47	0.809
Ka⁺/(mmol/L)	Pre-operative	3.9±0.3	4.0±0.3	0.452
Ka⁺/(mmol/L)	Post-operative	3.8±0.4	3.8±0.3	0.711
Na⁺/(mmol/L)	Pre-operative	140±1.7	140±2.0	0.502
Na⁺/(mmol/L)	Post-operative	140±2.6	139±3.0	0.295
Creatinine/(mmol/L)	Pre-operative	55±15	63±16	0.131
Creatinine/(mmol/L)	Post-operative	50±10	57±13	0.094
Prothrombin time/s	Pre-operative	11.7±1.1	11.2±0.9	0.098
Prothrombin time/s	Post-operative	12.4±1.4	12.3±1.4	0.819