■妇科肿瘤根治性手术对于拒绝输血的患者是可行的,当进行仔细的术前(血红蛋白优化和患者咨询),术中(止血和逐步断流术,血液稀释,和自体细胞回收)和术后(考虑铁输注或促红细胞生成素)计划,由多学科团队参与。
■我们描述了一个60多岁的女性耶和华见证人患者接受盆腔切除术的案例,专注于术前,术中,以及术后措施,允许在不输血的情况下进行简单的手术。输血在妇科肿瘤患者的外科治疗中很常见,高达93%的盆腔切除术患者可能需要血液制品。然而,越来越多的患者在接受血液制品时谨慎,要么是因为担心潜在的风险,要么是因为宗教信仰。因此,优化这些患者的管理以避免输血至关重要。在这种情况下,我们总结了一位60多岁接受剖腹手术的女士的治疗,盆腔切除术,Bricker结肠输尿管造口术,复发性子宫内膜癌的最终结肠造口术,尽管以前进行过全腹部子宫切除术和双侧附件卵巢切除术,然后进行近距离放射治疗,化疗,高级别浆液性癌的外放射治疗。术前,讨论了拒绝血液制品的预先决定,以确定所有合适的选择。由于她的术前血红蛋白是可以接受的(127克/升),无需进一步干预.术中,通过细致的止血有效地减少了失血,盆底分步断流术,术中血液稀释,和细胞抢救。尽管有这些干预措施,总失血量为1030mL,术后血红蛋白为113g/L。因此,术后措施包括静脉输注铁,最小化放血,和心肺状态的优化。促红细胞生成素也被考虑,但没有必要,因为患者对以前的措施反应良好,并且在简单的恢复后成功出院。在耶和华见证人患者的文献中,仅描述了很少的完全盆腔切除术。然而,我们的案例表明,在拒绝血液制品的患者中,剖腹手术和盆腔切除术是可行的,如果在多学科团队下进行,并且术前仔细,术中,和术后计划,在以前的根治性子宫切除术和辅助治疗中也是如此。
UNASSIGNED: Radical gynecology oncology surgeries are feasible in patients refusing blood transfusion, when performed with careful preoperative (with hemoglobin optimization and patients\' counseling), intraoperative (with hemostasis and stepwise devascularization, hemodilution, and autologous cell salvage) and postoperative (considering iron infusion or erythropoietin) planning with a multidisciplinary team involvement.
UNASSIGNED: We describe the case of a female Jehovah\'s Witness patient in her 60s undergoing pelvic exenteration, focusing on the preoperative, intraoperative, and postoperative measures that allowed an uncomplicated surgery without blood transfusion. Blood transfusions are common in the surgical management of gynecology oncology patients, up to 93% of patients undergoing pelvic exenteration may require blood products. However, increasingly more patients are cautious in receiving blood products, either for fear of potential risks or for religious believes. It is therefore vital to optimize the management of these patients in order to avoid blood transfusions. In this case, we summarize the management of a lady in her 60s who underwent laparotomy, pelvic exenteration, Bricker colicureterostomy, and end colostomy formation for recurrent endometrial carcinoma, despite previous total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by brachytherapy, chemotherapy, and external beam radiotherapy for high-grade serous carcinoma. Preoperatively, an advance decision to refuse blood products was discussed to ascertain all the options that were suitable. As her preoperative hemoglobin was acceptable (127 g/L), no further intervention was required. Intraoperatively, blood loss was effectively minimized with meticulous hemostasis, stepwise pelvic devascularization, intraoperative hemodilution, and cell salvage. Despite these interventions, total blood loss was 1030 mL and postoperative hemoglobin was 113 g/L. Postoperative measures therefore included intravenous iron infusion, minimization of phlebotomy, and optimization of cardiopulmonary status. Erythropoietin was also considered, but was not necessary as patient responded to the previous measures well and was successfully discharged after an uncomplicated recovery. Only few cases of total pelvic exenteration have been described in the literature for Jehovah\'s Witness patients. However, our case shows that laparotomy and pelvic exenteration is feasible in patients refusing blood products, if performed under a multidisciplinary team and with careful preoperative, intraoperative, and postoperative planning, also in the setting of previous radical hysterectomy and co-adjuvant therapy.