胃、结直肠癌患者手术前后贫血状况的多中心临床调查研究  

Multicenter cross-sectional study of anemia in patients with gastric and colorectal cancer before and after the operation

作　　者：于健春[1] 葛军娜[1] 唐云[2] 吴健雄[3] 肖刚[4] 于波[5] 尉承泽 王岩[7] 梁斌[8] 康维明[1] 杨华[4] 郑朝旭[3] 王文跃[7] 马志强[1] 

机构地区：[1]中国医学科学院北京协和医学院 北京协和医院基本外科,100730 [2]解放军总医院普通外科 [3]中国医学科学院肿瘤医院腹部外科 [4]北京医院普通外科 [5]北京军区总医院普通外科 [6]解放军第三○七医院普通外科 [7]北京中日友好医院普外科 [8]北京大学人民医院普通外科

出　　处：《中华外科杂志》2011年第1期53-56,共4页Chinese Journal of Surgery

基　　金：国家科技支撑计划资助项目（2008BA158802）

摘　　要：目的 明确胃、结直肠恶性肿瘤患者手术前后肿瘤性贫血、缺铁性贫血的发生率及其治疗现状.方法 前瞻性收集2009年8月至12月在北京市8家综合医院明确诊断为胃、结直肠恶性肿瘤的患者共262例,检测术前、术后7 d空腹静脉血血红蛋白、血清铁及铁蛋白水平,分析患者手术前后肿瘤性贫血和缺铁性贫血的发生率.结果 在131例胃癌患者中,手术前肿瘤相关性贫血发生率为36.6%,缺铁性贫血发生率为52.1%,其中贫血患者平均年龄高于无贫血患者年龄[（62±11）岁比（57±12）岁,P＜0.05];手术后缺铁性贫血发生率升至72.6%,明显高于术前（P＜0.05）.131例结直肠癌患者手术前肿瘤相关性贫血发生率为37.4%,缺铁性贫血发生率为61.2%,其中45%贫血患者结肠肿瘤部位为右半结肠癌;手术后缺铁性贫血发生率明显高于术前（76.7%,P＜0.05）.消化道肿瘤性贫血的术前治疗率为10.3%,术后治疗率为22.7%,半数以上的肿瘤性贫血患者接受了输血治疗.结论 胃、结直肠恶性肿瘤患者中缺铁性贫血及肿瘤相关性贫血发生率高,主要病因为缺铁性贫血.老年患者、右半结肠癌患者中贫血发生率高.贫血患者接受治疗比例较低,需要建立系统的肿瘤性贫血治疗规范.Objectives To determine the prevalence of cancer-related anemia and iron deficiency anemia（ IDA ） in patients with gastric and colorectal cancer in North of China. Methods A cross-sectional study of 262 inpatients diagnosed with gastric or colorectal cancer admitted to eight general hospitals in Beijing from August 2009 to December 2009 was performed. The blood samples were took on the day after admission and the seventh day after operation for the tests of hemoglobin, serum iron and ferritin. The morbidity of cancer-related anemia and IDA before and after the surgery was also compared respectively.Results The preoperative morbidity of cancer-related anemia was 36. 6% in 131 patients with gastric cancer, and the morbidity of IDA was 52. 1%. The mean age of the anemic patients was higher than that in cases without anemia[（62 ± 11 ） yrs vs. （57 ± 12） yrs, P 〈 0. 05]; the postoperative morbidity of IDA increased to 72. 6% （ P 〈 0. 05 ）. In the 131 cases with colorectal cancer, the preoperative incidence of cancer-related anemia and IDA was 37. 4% and 61.2%, respectively. About 45% of the cases with anemia had a tumor in the right colon. Postoperative incidence of IDA was significantly higher than that before the surgery （ 76. 7%, P 〈 0. 05 ）. Only 10. 3% of the anemic patients were treated with chalybeate therapy before surgical procedures, and the proportion was 22. 7% after the operation. More than 50% of anemic patient received blood transfusion. Conclusions Cancer-related anemia is a common clinical manifestation in patients with gastrointestinal cancer, and anemia occurs more frequently in elder and patients with right colon tumor. The treatment to cancer-related anemia is insufficient and a systematic therapy is needed to be established.

关 键 词：胃肿瘤 结直肠肿瘤 贫血 外科手术 

分 类 号：R735.3[医药卫生—肿瘤]