早期子宫颈癌患者术中失血量的危险因素分析
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摘要
目的探讨手术治疗早期子宫颈癌患者(ⅠB～ⅡA期)术中失血量的影响因素。方法回顾性分析2010年12月至2017年9月于四川大学华西第二医院住院手术治疗的早期子宫颈癌患者892例,分为两组,术中失血量≥500mL组127例,失血量<500mL组765例。收集患者临床病理资料,包括一般资料、有无盆腹腔手术史、肿瘤直径、病理类型、有无淋巴结转移、临床分期、手术方式、是否新辅助化疗(neoadjuvant chemotherapy,NACT)、NACT后手术时机选择、术前及术后血红蛋白、术中失血量及术中输血量等,多因素logistic回归分析该人群术中失血量的独立危险因素并进行危险分层。结果两组患者年龄、体质量指数(BMI)、妊娠次数、盆腔手术史占比、慢性盆腔炎史占比、子宫颈癌临床分期、手术方式、是否行NACT及NACT后手术时机差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,患者年龄≥40岁[偏回归系数(B)=2.100)]、BMI≥24kg/m2(相对于18.5～23.9kg/m2)(B=1.842)、临床分期为ⅡA期(相对于ⅠB期)(B=2.401)、手术方式为开腹手术(相对于腹腔镜)(B=1.347)、未行NACT(B=1.540)、于NACT后<2周及>3周手术(相对于2～3周内手术)(B=1.723)是术中失血量大(≥500mL)的独立危险因素。结论肿瘤临床分期和年龄等是早期子宫颈癌患者术中失血量大的独立影响因素。
Objective To determine risk factors associated with intraoperative blood loss in patients with early cervical cancer(stageⅠB-ⅡA).Methods The medical records of 892 patients who underwent surgical treatments for early cervical cancer in the Second West China University Hospital of from Dec 2010 to Sep 2017 were retrospectively reviewed:127having≥500mL intraoperative blood loss patients compared with 765 less than 500 mL.Differences between the two groups in age,body mass index(BMI),gravidity,history of abdominal and pelvic operations,chronic pelvic inflammation disease,clinical stage,methods of operation,neoadjuvant chemotherapy(NACT)and post-NACT operative opportunity,preoperative and postoperative hemoglobin,and intraoperative transfusion volume were analyzed through univariate and multivariate statistical methods.Results The univariate analyses identified age,BMI,gravidity,history of abdominal and pelvic operation,chronic pelvic inflammation disease,clinical stage,methods of operation,NACT and post-NACT operative opportunity assignificant factors associated with intraoperative blood loss(P<0.05).The multivariate logistic regression analysis confirmed that age≥40yr.[partial regression coefficient(B)=2.100)],BMI ≥24kg/m2(relative to 18.5-23.9kg/m2)(B=1.842),clinical stage ⅡA(relative to phase ⅠB,B=2.401),trans-abdominal operative method(relative to laparoscopy,B=1.347),no NACT(B=1.540)and post-NACT operative opportunity<2or>3weeks(relative to within 2-3weeks)(B=1.723)were independent predictors of higher intraoperative blood loss(≥500 mL).Conclusion Clinical stage and age,etc.are risk factors associated with intraoperative blood loss in patients with early cervical cancer.
Objective To determine risk factors associated with intraoperative blood loss in patients with early cervical cancer(stageⅠB-ⅡA).Methods The medical records of 892 patients who underwent surgical treatments for early cervical cancer in the Second West China University Hospital of from Dec 2010 to Sep 2017 were retrospectively reviewed:127having≥500mL intraoperative blood loss patients compared with 765 less than 500 mL.Differences between the two groups in age,body mass index(BMI),gravidity,history of abdominal and pelvic operations,chronic pelvic inflammation disease,clinical stage,methods of operation,neoadjuvant chemotherapy(NACT)and post-NACT operative opportunity,preoperative and postoperative hemoglobin,and intraoperative transfusion volume were analyzed through univariate and multivariate statistical methods.Results The univariate analyses identified age,BMI,gravidity,history of abdominal and pelvic operation,chronic pelvic inflammation disease,clinical stage,methods of operation,NACT and post-NACT operative opportunity assignificant factors associated with intraoperative blood loss(P<0.05).The multivariate logistic regression analysis confirmed that age≥40yr.[partial regression coefficient(B)=2.100)],BMI ≥24kg/m2(relative to 18.5-23.9kg/m2)(B=1.842),clinical stage ⅡA(relative to phase ⅠB,B=2.401),trans-abdominal operative method(relative to laparoscopy,B=1.347),no NACT(B=1.540)and post-NACT operative opportunity<2or>3weeks(relative to within 2-3weeks)(B=1.723)were independent predictors of higher intraoperative blood loss(≥500 mL).Conclusion Clinical stage and age,etc.are risk factors associated with intraoperative blood loss in patients with early cervical cancer.
引文
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[13]赵战强,胡建庭.腹腔镜手术应用于不同分期结肠癌的临床疗效观察.中国临床研究,2014,27(7):818-819.
[14]张琳,马国利,邵茵,等.宫颈浸润癌根治术中出血的因素分析及其预防的探讨(附149例).山西医科大学学报,2007,38(5):436-438.
[15]MORRIS EJ,TAYLOR EF,THOMAS JD,et al.Thirty-day postoperative mortality after colorectal cancer surgery in England.Gut,2011,60(6):806-813.
[16]FREI E,3rd.Clinical cancer research:an embattled species.Cancer,1982,50(10):1979-1992.
[17]郄明蓉.子宫颈癌新辅助化疗及其对手术的影响.中国妇产科临床杂志,2009,10(5):397-399.
[18]BOGANI G,CROMI A,SERATI M,et al.A prospective case-control study on the impact of neoadjuvant chemotherapy on surgery-related outcomes of laparoscopic radical hysterectomy.Anticancer Res,2014,34(10):5703-5708.
[19]VIZZA E,PELLEGRINO A,MILANI R,et al.Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stageⅠB2-ⅡB cervical cancer patients after neoadjuvant chemotherapy.Eur J Surg Oncol,2011,37(4):364-369.
[20]吕卫国,石一复.局部晚期子宫颈癌的新辅助化疗.国外医学妇产科分册,2000,27(1):37-38.
[2]FERLAY J,SOERJOMATARAM I,DIKSHIT R,et al.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012.Int J Cancer,2015,136(5):E359-E386.
[3]OHARA K,SUGAHARA S,KAGEI K,et al.Retrospective comparison of clinical outcome between radiotherapy alone and surgery plus postoperative radiotherapy in the treatment of stagesⅠB-ⅡB cervical squamous cell carcinoma.Radiat Med,2004,22(1):42-48.
[4]STEED H,ROSEN B,MURPHY J,et al.A comparison of laparascopic-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer.Gynecol Oncol,2004,93(3):588-593.
[5]王敏.腹腔镜下广泛性子宫切除术联合盆腔淋巴结清扫术治疗子宫颈癌的效果分析.河南医学研究,2018(1):79-80.
[6]解国琦,谭保斌,李茂竹主编.手术中的疑难问题及紧急处理.北京:北京医科大学中国协和医科大学联台出版社,1995:17.
[7]中华人民共和国疾病控制司.中国成人超重和肥胖预防控制指南.北京:人民卫生出版社,2006:1-8.
[8]PETTERSSON AF,WAHLUND LO,BRONGE L,et al.Physical activity level in people with age related white matter changes correlates to better motor performance,lower comorbidity and higher cognitive level.BMC Geriatr,2017,17(1):142[2018-04-05].https://doi.org/10.1186/s12877-017-0535-z.
[9]YAN RT,YAN AT,ANDERSON TJ,et al.The differential association between various anthropometric indices of obesity and subclinical atherosclerosis.Atherosclerosis,2009,207(1):232-238.
[10]VARNER M,RICE M,LANDON M,et al.Pregnancies after the diagnosis of mild gestational diabetes mellitus and risk of cardiometabolic disorders,Obstet Gynecol,2017,129(2):273-280.
[11]COHN DE,SWISHER EM,HERZOG TJ,et al.Radical hysterectomy for cervical cancer in obese women.Obstet Gynecol,2000,96(5Pt 1):727-731.
[12]FRUMOVITZ M,SUN CC,JHINGRAN A,et al.Radical hysterectomy in obese and morbidly obese women with cervical cancer.Obstet Gynecol,2008,112(4):899-905.
[13]赵战强,胡建庭.腹腔镜手术应用于不同分期结肠癌的临床疗效观察.中国临床研究,2014,27(7):818-819.
[14]张琳,马国利,邵茵,等.宫颈浸润癌根治术中出血的因素分析及其预防的探讨(附149例).山西医科大学学报,2007,38(5):436-438.
[15]MORRIS EJ,TAYLOR EF,THOMAS JD,et al.Thirty-day postoperative mortality after colorectal cancer surgery in England.Gut,2011,60(6):806-813.
[16]FREI E,3rd.Clinical cancer research:an embattled species.Cancer,1982,50(10):1979-1992.
[17]郄明蓉.子宫颈癌新辅助化疗及其对手术的影响.中国妇产科临床杂志,2009,10(5):397-399.
[18]BOGANI G,CROMI A,SERATI M,et al.A prospective case-control study on the impact of neoadjuvant chemotherapy on surgery-related outcomes of laparoscopic radical hysterectomy.Anticancer Res,2014,34(10):5703-5708.
[19]VIZZA E,PELLEGRINO A,MILANI R,et al.Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stageⅠB2-ⅡB cervical cancer patients after neoadjuvant chemotherapy.Eur J Surg Oncol,2011,37(4):364-369.
[20]吕卫国,石一复.局部晚期子宫颈癌的新辅助化疗.国外医学妇产科分册,2000,27(1):37-38.