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【Objective】 To explore the influencing factors of perioperative red blood cell transfusion in patients underwent lung transplantation, so as to provide reference for perioperative blood management (PBM) of lung transplantation patients. 【Methods】 The clinical data of 173 lung transplant patients completed in China-Japan Friendship Hospital from March 2017 to June 2019 were retrospectively analyzed. The patients were divided into two groups according to perioperative red blood cell transfusion volume: large blood transfusion group (transfusion red blood cell volume ≥6 U, n=66) and non-large blood transfusion group (red blood cell transfusion volume <6 U, n=107). The basic information, preoperative laboratory test results, and surgical status of the two groups were statistically analyzed.The clinical data of the two groups were analyzed by univariate analysis. The factors of P<0.15 were included in the binary logistic regression analysis, and the independent influencing factors of perioperative massive blood transfusion in patients with lung transplantation were found. 【Results】 Univariate analysis of clinical data of the two groups of patients (large blood transfusion group vs. non-large blood transfusion group) showed that the differences of smoking history ratio [44(66.7%) vs 87(81.3%)], BMI(20.8±4.5 vs 22.5±4.0)(P<0.05), preoperative Hb [124(111, 138.8) vs 138(126, 149)], preoperative Hct [37.9(34.8, 42.5) vs 41.3(37.9, 44.6)], surgery duration(327.9±107.7 vs 238.4±77.0), intraoperative blood loss(1 108.6±1342.0 vs 341.8±270.8) and single lung transplantation [28(42.4%) vs 84(78.5%)] (P<0.01) were statistically significant. Logistic regression analysis showed that intraoperative blood loss (OR=1.001, P<0.05), surgery duration (OR=1.006, P<0.05), preoperative Hb (OR=0.973, P<0.01), lung transplantation type(single or double lung transplantation)( OR=0.247, P<0.05) and extracorporeal membrane oxygenation (ECMO) (OR=0.187, P<0.01) were independent factors influencing red blood cell transfusion during lung transplantation. 【Conclusion】 Intraoperative blood loss and surgery duration are risk factors for massive blood transfusion during the perioperative period. And the use of ECMO, preoperative Hb, single lung transplantation (compared to double lung transplantation) are protective factors for perioperative massive blood transfusion.
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【Objective】 To study the effect of intravenous immunoglobulin(IVIG) on the detection of blood transfusion compatibility in patients. 【Methods】 56 patients, submitted to our Hospital from March 1, 2017 to December 31, 2020, were enrolled as the research objects. They had negative unexpected antibody screening, major crossmatch incompatibility with the same blood type donors, and had a history of IVIG infusion. ABO and RhD blood groups typing, unexpected antibodies screening, crossmatch, direct antiglobulin test, indirect antiglobulin test, and acid elution test were all conducted by microcolumn gel method. 【Results】 After IVIG infusion, the initially major crossmatch incompatibility with the same blood type donors turned into compatiblity with O-type donors. Among them, 2 patients had transient discrepancy in ABO forward and reverse blood typing due to the IVIG infusion. IgG anti-A were detected in the red blood cell elution of 37 A-type patients; IgG anti-B in 2 B-type patients; 3 cases of IgG anti-A+ anti-B and 14 cases of solo IgG anti-A in 17 AB-type patients. 3 batches of IVIG preparations were detected randomly, IgG anti-A titer was 32-64, and IgG anti-B titer was 8-16. 【Conclusion】 The discrepancy in ABO forward and reverse blood typing and major crossmatch incompatibility with the same blood type donors may occur after non-O type patients received IVIG, which contains IgG types of anti-A and anti-B. In this situation, it is recommended to prepare major crossmatched O-type washed red blood cells to ensure the safety and effectiveness of clinical blood transfusion.
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Objective:To evaluate perioperative coagulatory parameters and transfusion rates of lung transplantation recipients.Methods:Clinical data were retrospectively reviewed for 178 lung transplant recipients at China-Japan Friendship Hospital from March 2017 to July 2019. According to whether extracorporeal membrane oxygenation(ECMO)was used during perioperative period, they were divided into two groups of ECMO(131 cases)and without ECMO(47 cases). Clinical data, laboratory examinations and blood transfusion status of two groups were compared. In ECMO group, excluding secondary thoracotomy for hemostasis(7 cases)and incomplete data(2 cases), the remainders were divided into the groups of no red blood cell transfusion(63 cases), red blood cell transfusion(59 cases), plasma transfusion <1 000 ml(99 cases)and plasma transfusion≥1 000 ml (23 cases), no platelet transfusion(93 cases)and platelet transfusion(29 cases). Clinical data, laboratory examinations and ECMO-related parameters of recipients were analyzed by Bary Logistic regression.Results:Statistically significant inter-group differences existed in body mass index(BMI), disease course, primary disease, bilateral lung transplantation, laboratory examinations, postoperative blood transfusion volume, postoperative red blood cell and plasma transfusion ratio between groups with and without ECMO( P<0.05). Bilateral lung transplantation, ASA grade, differences in BMI, disease course, postoperative hemoglobin<100 g/L, postoperative PT/APTT/INR abnormalities and postoperative PLT count <100×10 9/L were independent risk factors for postoperative transfusion during ECMO. Conclusions:The application of ECMO during lung transplantation may affect the perioperative transfusion volume and demand.Fully assessing blood transfusion requirements, optimizing coagulation monitoring and identifying the independent influencing factors of postoperative blood transfusion facilitate clinical scientific and rational blood transfusions.
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Metastatic seminal vesicle carcinoma is rare in clinic.The case of renal clear cell carcinoma metastasis to the seminal vesicle gland is more rare,which is difficult to be identified with bladder,prostate and colorectal tumors.In November 2017,1 case of renal clear cell carcinoma metastasis to the left side of the seminal vesicle gland was admitted in our hospital.Laparoscopy seminal vesicle metastasis tumor resection was performed.Regular bladder irrigation and sunitib oral intake were conducted.No evidence of local recurrence was found within 19 months follow-up.
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Metastatic seminal vesicle carcinoma is rare in clinic. The case of renal clear cell carcinoma metastasis to the seminal vesicle gland is more rare, which is difficult to be identified with bladder, prostate and colorectal tumors. In November 2017, 1 case of renal clear cell carcinoma metastasis to the left side of the seminal vesicle gland was admitted in our hospital.Laparoscopy seminal vesicle metastasis tumor resection was performed. Regular bladder irrigation and sunitib oral intake were conducted. No evidence of local recurrence was found within 19 months follow-up.
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Objective To study the expression of NF-κB and COX-2 protein in renal cell carcinoma, and to investigate the clinical value of it in the occurrence, progression and metastasis of renal cell carcinoma as well as the prognosis of patients. Methods 48 cases of renal cell carcinoma tissues and 5 cases of normal renal tissues were detected by using immunohistochemical method, and following up the patients who were included in the study. Then we analyzed the relationship between NF-κB and COX-2 protein level and clinic pathological parameters as well as the prognosis of patients. Resalts The expression of NF-κB and COX-2 protein were increasing in renal cell carcinoma, the protein levels were significantly different compared with that in normal renal tissues(P <0.05). There were significantly positive correlation between the expression of NF-κB protein and the clinic stages of renal cell earcinoma(P <0.05), but no correlation between the expression of COX-2 protein and them(P >0.05). There were significantly negative correlation between the expression of COX-2 protein and the pathological grades of renal cell careinoma(P <0.05), but no correlation between the expression of NF-κB protein and them (P>O.05). The survival rate of these patients whose expression of NF-κB protein were positive was significantly lower than those of negative expression of NF-κB protein(P <0.05), and there was opposite result for COX-2, but not significanfly(P >0.05). The expression of NF-κB and COX-2 protein in renal cell carcinoma had no significant correlation (P >0.05). Conclusion There may be relationship between the expression of NF-κB and COX-2 protein and the occurrence, progression of renal cell carcinoma, the expression of NF-κB may also have association with metastasis of renal cell carcinoma as well as the prognosis of patients. Detecting the expression of NF-κB and COX-2 protein may be useful in early diagnosis of renal cell carcinoma as well as prognosis evaluation of patients.
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Objective To evaluate the detenia cecocolon urinary reservoir for 30 patients with bladder cancer after total cystectomy. Methods A detenia continent cecocolon urinary reservoir was constructed for 30 patients with bladder cancer after total cystectomy. Results The patients have been followed up for 8～40 months. The capacity of the reservoir has been 360～580 ml with a maximum pressure of 19.5～78.5 cmH 2O one year later .Good continence has been achieved during day time in 93% and at night in 90%. Unileteral ureter stenosis and slight hydronephrosis was found on ultrasonography,IVU and pouch photography in 1 case. There has been no evidence of ureter reflux or impairment of renal function and serum electrolytes have been normal in all. Conclusions Detenia continent cecocolon pouch is fairly good for urinary diversion and the technique is simpler, easier with minimal complications.
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Objective To modify and improve the technique of continent outlet and to find an optional method of simpler construction and easier catheterization. Methods 47 patients underwent continent cecal-ascending colon urinary reservoir were followed up,among whom 37 were detenial and 10 were detubularized. All reservoirs used incisive terminal ileum being overlapped and sutured again as efferent tube. The limb was fixed between the back surface of the rectus and the pouch wall. The internal orifice of the overlapped ileum was ileocecal valve reinforced with few sutures.Its external orifice was anastomosed to the umbilicus.Urodynamic studies of the pouch and efferent limb were carried out more than 6 months postoperatively. Results All the tubes were easily catheterized with 16 F catheter.45/47 patients were completely continent during the day and 44/47 patients completely continent at night. Urodynamic study of the efferent tubes showed that the maximum close pressure with the pouch full was significantly higher than with the pouch empty( P
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Objective To examine the effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. Methods A total of 73 consecutive male patients underwent cystectomy and construction of a colonic reservoir with low pressure.Of them nerve sparing were attempted in 48 cases (study group) and non nerve sparing in 25 (control group).The patients were followed up for 3 to 28 months.Postoperative continence was compared between the 2 groups through questionnaires and urinary pad test. Results After removal of the urinary catheter the continence rate was 65% in nerve sparing group and 34% in non nerve sparing group during the day;and it was 40% and 26%,respectively,at night.The mean time from post operation to continence during the day and at night in nerve sparing group was 2 and 4 months,respectively;while it was 5 and 10 months,respectively in non nerve sparing group.Twelve months after operation,the continence rate of nerve sparing group and non nerve sparing group was 96% and 79% during the day;and it was 87% and 64% at night,respectively.Continence differed significantly between the two groups (day, P =0.002;night, P =0.001). Conclusions Nerve sparing cystectomy is associated with improved urinary continence after orthotopic bladder substitution.