围手术期输血对不同分期肝门部胆管癌根治性切除术患者远期生存的影响  

Impact of Perioperative Blood Transfusion on Long-term Survival of Patients Undergoing Radical Resection for Different Stages of Perihilar Cholangiocarcinoma

作　　者：姚劼靖 车晓宇 潘宇 罗宇乐 赵小林 刘洁 张进 刘兴超[2] 庞书杰 张庆仪 Yao Jiejing;Che Xiaoyu;Pan Yu(Department of Hepatobiliary Surgery,Institute of Hepatobiliary Surgery,First Affiliated Hospital of Army Medical University,Chongqing 400038,China)

机构地区：[1]陆军军医大学第一附属医院肝胆外科,重庆400038 [2]四川省人民医院肝胆外科,四川成都610072 [3]海军军医大学附属东方肝胆医院肝胆外科,上海200438

出　　处：《四川医学》2025年第3期301-307,共7页Sichuan Medical Journal

摘　　要：目的探讨围手术期输血(PBT)对不同分期肝门部胆管癌(pCCA)根治性切除术患者远期生存的影响。方法回顾性收集2012年1月至2019年1月在陆军军医大学第一附属医院、四川省人民医院、海军军医大学附属东方肝胆医院收治的接受根治性切除术的pCCA患者临床资料。将所有患者按是否接受PBT分成两组,即输血组与未输血组。比较两组的基线资料、总生存时间(OS)、无复发生存时间(RFS)。本研究采用倾向性评分匹配(PSM)平衡两组的基线资料差异。Cox回归模型确定影响OS与RFS的独立危险因素。根据第8版美国癌症联合委员会(AJCC)分期,将所有患者分为早期亚组(AJCCⅠ期)和非早期亚组(AJCCⅡ~Ⅳ期)。在不同亚组中探讨PBT对pCCA根治性切除术患者的OS和RFS的影响。结果共收集到306例患者纳入分析,其中输血组132例,未输血组174例。PSM后,两组患者的OS率和RFS率比较,差异均无统计学意义(P>0.05)。早期患者70例,其中输血组23例,未输血组47例。PSM后,输血组患者的OS率和RFS率均显著低于未输血组,差异均有统计学意义(P<0.05)。非早期患者236例,其中输血组109例,未输血组127例。PSM后,两组患者的OS率和RFS率比较,差异均无统计学意义(P>0.05)。Cox回归模型提示,PBT是影响早期pCCA患者OS和RFS的独立危险因素。结论在接受根治性切除治疗的早期pCCA患者中,PBT被证明与更差的长期生存率独立相关,但在非早期阶段的患者中未见这种影响。Objective To explore the influence of perioperative blood transfusion(PBT)on long-term survival of patients undergoing radical resection for different stages of perihilar cholangiocarcinoma(pCCA).Methods From January 2012 and January 2019,clinical data of pCCA patients who underwent radical resection were retrospectively collected.Patients were divided into two groups,transfusion group and non-transfusion group,based on whether they received PBT.Baseline characteristics,overall survival(OS),and recurrence-free survival(RFS)were compared.Propensity score matching(PSM)was used to balance baseline differences.Cox regression models were used to determine independent risk factors affecting OS and RFS.According to the 8th edition of the American Joint Committee on Cancer(AJCC)staging system,all patients were divided into early-stage subgroup(AJCC stageⅠ)and non-early-stage subgroup(AJCC stageⅡ~Ⅳ).The impact of PBT on OS and RFS of pCCA patients undergoing radical resection was explored in different subgroups.Results Total 306 patients were included,with 132 in transfusion group and 174 in non-transfusion group.After PSM,there were no statistically significant differences in OS and RFS rates(P>0.05).Among the 70 early-stage patients,including 23 in transfusion group and 47 in non-transfusion group,the OS and RFS rates in transfusion group were significantly lower than those in non-transfusion group after PSM(P<0.05).Among the 236 non-early-stage patients,including 109 in transfusion group and 127 in non-transfusion group,there were no statistically significant differences in OS and RFS rates after PSM(P>0.05).Cox regression models indicated that PBT was an independent risk factor affecting OS and RFS in early-stage pCCA patients.Conclusion In early-stage pCCA patients undergoing radical resection,PBT was found to be independently associated with poorer long-term survival,while this effect was not observed in non-early-stage patients.

关 键 词：围手术期输血 肝门部胆管癌 根治性手术 远期生存 倾向性评分匹配 

分 类 号：R657.3[医药卫生—外科学]