대한골관절종양학회지 (The Journal of the Korean bone and joint tumor society)

  • 제20권1호
  • /
  • Pages.36-40
  • /
  • 2014
  • /
  • 1226-4962(pISSN)
  • /
  • 2233-9841(eISSN)
대한근골격종양학회 (The Korean Musculoskeletal Tumor Society)
권호 표지
DOI QR코드

DOI QR Code

무수혈로 진행한 대퇴골 원위부 골육종 사지구제술: 증례 보고

Non Blood Transfusion Limb Salvage Operation in the Distal Femur Osteosarcoma Patient: A Case Report

  • 박종훈 (고려대학교병원 정형외과) ;
  • 박시영 (고려대학교병원 정형외과) ;
  • 이대희 (고려대학교병원 정형외과) ;
  • 황역구 (고려대학교병원 정형외과) ;
  • 이현민 (고려대학교병원 정형외과)
  • Park, Jong Hoon (Department of Orthopedic Surgery, Korea University Hospital) ;
  • Park, Si-Young (Department of Orthopedic Surgery, Korea University Hospital) ;
  • Lee, Dae Hee (Department of Orthopedic Surgery, Korea University Hospital) ;
  • Hwang, Yeok Gu (Department of Orthopedic Surgery, Korea University Hospital) ;
  • Lee, Hyun Min (Department of Orthopedic Surgery, Korea University Hospital)
  • 투고 : 2014.03.15
  • 심사 : 2014.06.02
  • 발행 : 2014.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

사지에 발생한 골육종에서의 사지구제술은 광범위 절제술을 기본으로 한다. 수술 전 항암 치료를 한 뒤에 시행하는 경우가 대부분이라 수술전에 빈혈인 경우가 많고 수술로 인한 출혈이 많아서 수술 전 후 빈혈 교정의 필요성이 대부분 존재한다. 수혈이 암 환자의 예후와 합병증 및 수술 후 치료 결과에 나쁜 영향을 미친다는 다양한 보고들이 있음에도 불구하고 사지 구제술에서 빈혈을 교정하기 위한 방편으로 수혈은 여전히 통상적인 치료로 간주되고 있다. 이에 저자들은 대퇴골 원위부에 발생한 골육종 환자의 사지구제술을 무수혈로 시행하였기에 문헌 고찰과 함께 증례 보고 한다.

Limb salvage operations for osteosarcoma of the extremity usually consist of wide excision and skeletal reconstruction. Most osteosarcoma patients are anemic prior to the surgery as majority of them undergo preoperative neo-adjuvant chemotherapy; thus, it is necessary to treat anemia before and after the surgery since limb salvage operation tends to accompany significant blood loss. Despite the fact that blood transfusion has bad influence on prognosis, complication, and postoperative outcome of cancer patients, it is still considered as a standard management to fix anemia for limb salvage operations. We would like to present a case report in which the authors succeeded in performing limb salvage operations on patients with distal femur osteosarcoma without transfusion.

키워드

참고문헌

  1. Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res. 2002;102:237-44. https://doi.org/10.1006/jsre.2001.6330
  2. Sugezawa A, Kaibara N, Sumi K, et al. Blood transfusion and the prognosis of patients with gastric cancer. J Surg Oncol. 1989;42:113-6. https://doi.org/10.1002/jso.2930420209
  3. Wells AW, Mounter PJ, Chapman CE, Stainsby D, Wallis JP. Where does blood go? Prospective observational study of red cell transfusion in north England. BMJ. 2002;325:803-6. https://doi.org/10.1136/bmj.325.7368.803
  4. Gombotz H, Rehak PH, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion. 2007;47:1468-80. https://doi.org/10.1111/j.1537-2995.2007.01286.x
  5. Speiss BD. Transfusion and outcome in heart surgery. Ann Thorac Surg. 2002;74:986-7. https://doi.org/10.1016/S0003-4975(02)03906-1
  6. Seeber P, Shander A. Basics of blood management. 2nd ed. West Sussex: Wiley-Blackwell; 2012. 148.
  7. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466:1710-5. https://doi.org/10.1007/s11999-008-0209-4
  8. Pape A, Habler O. Alternatives to allogeneic blood transfusions. Best Pract Res Clin Anaesthesiol. 2007;21:221-39.
  9. Kiss H, Raffl M, Neumann D, Hutter J, Dorn U. Epinephrineaugmented hypotensive epidural anesthesia replaces tourniquet use in total knee replacement. Clin Orthop Relat Res. 2005;(436):184-9.
  10. Ong SM, Taylor GJ. Can knee position save blood following total knee replacement? Knee. 2003;10:81-5. https://doi.org/10.1016/S0968-0160(02)00076-5
  11. Bock M, Muller J, Bach A, Bohrer H, Martin E, Motsch J. Effects of preinduction and intraoperative warming during major laparotomy. Br J Anaesth. 1998;80:159-63. https://doi.org/10.1093/bja/80.2.159
  12. Waters JH, Donnenberg AD. Blood salvage and cancer surgery: should we do it? Transfusion. 2009;49:2016-8. https://doi.org/10.1111/j.1537-2995.2009.02379.x
  13. Yoo YC, Shim JK, Kim JC, Jo YY, Lee JH, Kwak YL. Effect of single recombinant human erythropoietin injection on transfusion requirements in preoperatively anemic patients undergoing valvular heart surgery. Anesthesiology. 2011;115:929-37. https://doi.org/10.1097/ALN.0b013e318232004b