bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.25837/HAT.2018.96..1..007bloodjour-88Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПРОБЛЕМА БАКТЕРИАЛЬНОЙ КОНТАМИНАЦИИ РЕИНФУЗАТА ПРИ УДАЛЕНИИ ЮНОШЕСКИХ АНГИОФИБРОМ ОСНОВАНИЯ ЧЕРЕПАTHE PROBLEM OF BACTERIAL CONTAMINATION OF REINFUSED BLOOD SPILLED DURING SURGERY FOR JUVENILE NASAL ANGIOFIBROMAhttps://orcid.org/0000-0003-2719-5031НерсесянM. В.NersesyanM. V.https://orcid.org/0000-0003-2595-5877ЛубнинA. Ю.LubninA. Yu.Lubnin@nsi.ruhttps://orcid.org/0000-0002-3074-0486СазыкинаС. Ю.SazykinaS. Yu.https://orcid.org/0000-0003-3004-2140КапитановД. Н.KapitanovD. N.https://orcid.org/0000-0002-9965-4578МошкинA. В.MoshkinA. V.https://orcid.org/0000-0001-5640-9743АлександроваИ. A.AleksandrovaI. A.ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н. Н. Бурденко» Министерства здравоохранения России, МоскваРоссияBurdenko National Medical Research Center of Neurosurgery, MoscowRussian FederationФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н. Н. Бурденко» Министерства здравоохранения РоссииРоссияBurdenko National Medical Research Center of Neurosurgery, MoscowRussian Federation2018180420196317177Copyright © Нерсесян M.В., Лубнин A.Ю., Сазыкина С.Ю., Капитанов Д.Н., Мошкин A.В., Александрова И.A., 20192019Нерсесян M.В., Лубнин A.Ю., Сазыкина С.Ю., Капитанов Д.Н., Мошкин A.В., Александрова И.A.Nersesyan M.V., Lubnin A.Y., Sazykina S.Y., Kapitanov D.N., Moshkin A.V., Aleksandrova I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/88

Значительная по объему операционная кровопотеря является относительно частым осложнением при хирургическом удалении юношеских ангиофибром основания черепа (ЮАОЧ), для компенсации которой часто используется аппаратная реинфузия аутоэритроцитов, полученная из раневой крови. Однако высокая частота встречаемости воспалительных изменений в околоносовых пазухах носа у пациентов с ЮАОЧ ставит вопрос о возможной бактериальной контаминации реинфузата. В связи с этим мы провели бактериологическое исследование проб крови, полученной на разных этапах обработки в аппарате для возврата аутологичной крови Cell Saver, в ходе 12 операций у 11 пациентов с ЮАОЧ, а также содержимого околоносовых пазух у 7 пациентов. Бактериальная контаминация была подтверждена последующим ростом гемокультур в 11 из 12 случаев. Ни у одного из пациентов в послеоперационном периоде не было отмечено признаков генерализации инфекции и сепсиса.

The juvenile nasal angiofibroma (JNA) surgeries are very often complicated by massive intraoperative blood loss. In order to compensate it the intraoperative blood reinfusion of autologous erythrocytes from operative field by cellsaver is very often used. But the high probability of chronic inflammation of blocked sinuses in patients with JNA raised the question of possible bacterial contamination of reinfused blood. In this context we have carried out the bacterial tests of blood samples of different steps’ cell-saver recycling in 11 patients with JNA during 12 surgeries and analized the bacterial status of sinuses in 7 of them. The bacterial contamination was confirmed by the following growth of hemoculture in 11 out of 12 observations. None of our patients was diagnosed with symptoms of generalization of contamination or sepsis in the postoperative period.

юношеские ангиофибромы основания черепааппаратная реинфузия эритроцитовбактериальная контаминация реинфузатабактериемияjuvenile nasal angiofibroma — JNAreinfusioncell-saverbacterial contaminationbacteremiaReferencesЛубнин А. Ю., Громова В. В., Ханзен Э. Реинфузия крови в хирургии. — Тверь: Триада, 2013.Лубнин А. Ю., Громова В. В., Ханзен Э. Реинфузия крови в хирургии. — Тверь: Триада, 2013.Гольбин Д. А., Черекаев В. А., Голанов А. И. и др. Тактика лечения распространенных краниофациальных ювенильных ангиофибром. Онкохирургия 2012; 4:5—14.Гольбин Д. А., Черекаев В. А., Голанов А. И. и др. Тактика лечения распространенных краниофациальных ювенильных ангиофибром. Онкохирургия 2012; 4:5—14.Нерсесян М. В., Капитанов Д. Н., Шелеско Е. В., Зинкевич Д. Н. Дифференцированный подход к диагностике и лечению юношеских ангиофибром основания черепа. Техника эндоскопических операций. Журнал оториноларингологии и респираторной патологии (Folia Otorhinolaryngologiae et Pathologiae Respiratoriae) 2017; 23:17—34.Нерсесян М. В., Капитанов Д. Н., Шелеско Е. В., Зинкевич Д. Н. Дифференцированный подход к диагностике и лечению юношеских ангиофибром основания черепа. Техника эндоскопических операций. Журнал оториноларингологии и респираторной патологии (Folia Otorhinolaryngologiae et Pathologiae Respiratoriae) 2017; 23:17—34.Leong SC. A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope 2013; 123:1125—1131. doi:10.1002/lary.23760.Leong SC. A systematic review of surgical outcomes for advanced juvenile nasopharyngeal angiofibroma with intracranial involvement. Laryngoscope 2013; 123:1125—1131. doi:10.1002/lary.23760.Lund VJ, Stammberger H, Nicolai P et al. European position paper on endoscopic management of tumors of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; 22:1—143.Lund VJ, Stammberger H, Nicolai P et al. European position paper on endoscopic management of tumors of the nose, paranasal sinuses and skull base. Rhinol Suppl 2010; 22:1—143.Nersesyan M, Kapitanov D, Lopatin A et al. Our experience in endoscopic management of relapsed juvenile nasal angiofibroma. Eur Arch Otolaryngol 2009; 266:1076—7. doi:10.1007/s00405-009-0987-7.Nersesyan M, Kapitanov D, Lopatin A et al. Our experience in endoscopic management of relapsed juvenile nasal angiofibroma. Eur Arch Otolaryngol 2009; 266:1076—7. doi:10.1007/s00405-009-0987-7.Rowan NR, Zwagerman ME, Heft-Neal PA et al. Juvenile nasal angiofibromas: A comparison of modern staging systems in an endoscopic era. J Neurol Surg 2017; 78:63—67. doi:10.1055/s-0036-1584903.Rowan NR, Zwagerman ME, Heft-Neal PA et al. Juvenile nasal angiofibromas: A comparison of modern staging systems in an endoscopic era. J Neurol Surg 2017; 78:63—67. doi:10.1055/s-0036-1584903.Snyderman CH, Pant H, Carrau RL et al. A new endoscopic staging system for angiofibromas. Arch. Otolaryngol. Head Neck Surg 2010; 136:588—594. doi:10.1001/archoto.2010.83.Snyderman CH, Pant H, Carrau RL et al. A new endoscopic staging system for angiofibromas. Arch. Otolaryngol. Head Neck Surg 2010; 136:588—594. doi:10.1001/archoto.2010.83.Lopez F, Triantafyllou A, Snyderman CH et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017; 39:1033—1045. doi:10.1002/hed.24696.Lopez F, Triantafyllou A, Snyderman CH et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017; 39:1033—1045. doi:10.1002/hed.24696.Dahl JP, Zopf DA, Parikh SR. Do open and endoscopic resection approaches to juvenile angiofibroma results in similar blood loss and recurrence rates? Laryngoscope 2015; 125:2436—2437. doi:10.1002/lary.25471.Dahl JP, Zopf DA, Parikh SR. Do open and endoscopic resection approaches to juvenile angiofibroma results in similar blood loss and recurrence rates? Laryngoscope 2015; 125:2436—2437. doi:10.1002/lary.25471.Latoo MA, Hamid WU, Jallu AS et al. Nasopharyngeal angiofibroma: Paradigma shift in management. Indian J Otolaryngol Head Neck Surg 2017; 69:47—51. doi:10.1007/s12070-016-1049-2.Latoo MA, Hamid WU, Jallu AS et al. Nasopharyngeal angiofibroma: Paradigma shift in management. Indian J Otolaryngol Head Neck Surg 2017; 69:47—51. doi:10.1007/s12070-016-1049-2.Cherekaev VA, Golbin DA, Kapitanov DN et al. Advanced craniofacial juvenile nasopharyngeal angiofibroma. Description of surgical series cases report, and review of the literature. Acta Neurochir (Wien) 2011; 153:499— 508. doi:10.1007/s00701-010-0922-0.Cherekaev VA, Golbin DA, Kapitanov DN et al. Advanced craniofacial juvenile nasopharyngeal angiofibroma. Description of surgical series cases report, and review of the literature. Acta Neurochir (Wien) 2011; 153:499— 508. doi:10.1007/s00701-010-0922-0.Renkonen S, Hagstrom J, Vuola J et al. The changing surgical management of juvenile nasopharyngeal angiofibroma. Eur Arch Otolaryngol 2011; 268:599—607. doi:10.1007/s00405-010-1383-z.Renkonen S, Hagstrom J, Vuola J et al. The changing surgical management of juvenile nasopharyngeal angiofibroma. Eur Arch Otolaryngol 2011; 268:599—607. doi:10.1007/s00405-010-1383-z.Boghani Z, Husain Q, Kammuri VV et al. Juvenile nasopharyngeal angiofibroma: A systematic review and comparison of endoscopic, endoscopic-assisted and open resection in 1047 cases. Laryngoscope 2013; 123:859—869. doi:10.1002/lary.23843.Boghani Z, Husain Q, Kammuri VV et al. Juvenile nasopharyngeal angiofibroma: A systematic review and comparison of endoscopic, endoscopic-assisted and open resection in 1047 cases. Laryngoscope 2013; 123:859—869. doi:10.1002/lary.23843.Fyrmpas G, Konstantinidis I, Constantinidis J. Endoscopic treatment of juvenile nasopharyngeal angiofibromas: our experience and review of the literature. Eur Arch Otorhinolaryngol 2012; 269:523—529. doi:10.1007/s00405-011-1708-6.Fyrmpas G, Konstantinidis I, Constantinidis J. Endoscopic treatment of juvenile nasopharyngeal angiofibromas: our experience and review of the literature. Eur Arch Otorhinolaryngol 2012; 269:523—529. doi:10.1007/s00405-011-1708-6.Garofalo P, Pia F, Policarpo M et al. Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches. J Craniofac Surg 2015; 26:918—921. doi:10.1097/SCS.0000000000001693.Garofalo P, Pia F, Policarpo M et al. Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches. J Craniofac Surg 2015; 26:918—921. doi:10.1097/SCS.0000000000001693.Khouier N, Nicolas N, Rohayem Z et al. Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: A systematic review of the literature. Otolaryngol Head Neck Surg 2014; 150:350—358. doi:10.1177/0194599813516605.Khouier N, Nicolas N, Rohayem Z et al. Exclusive endoscopic resection of juvenile nasopharyngeal angiofibroma: A systematic review of the literature. Otolaryngol Head Neck Surg 2014; 150:350—358. doi:10.1177/0194599813516605.Santos-Franco JA, Lee A, Campos-Navarro LA et al. Bilateral nonsuperselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note. Vasc Endovasc Surg 2012; 46:559—564. doi:10.1177/153854412456436.Santos-Franco JA, Lee A, Campos-Navarro LA et al. Bilateral nonsuperselective embolization with particles under transient occlusion of the internal carotid artery in the management of juvenile nasopharyngeal angiofibroma: technical note. Vasc Endovasc Surg 2012; 46:559—564. doi:10.1177/153854412456436.Thanbahuy P, Borsik M, Herman P et al. Direct intratumoral embolization of juvenile angiofibroma. Am J Otolaryngol 1994; 15:429—435.Thanbahuy P, Borsik M, Herman P et al. Direct intratumoral embolization of juvenile angiofibroma. Am J Otolaryngol 1994; 15:429—435.Арустамян С. Р., Лубнин А. Ю. Эмболизация сосудов при опухолях головного мозга. Вопросы нейрохирургии 2000; 64:30—34.Арустамян С. Р., Лубнин А. Ю. Эмболизация сосудов при опухолях головного мозга. Вопросы нейрохирургии 2000; 64:30—34.Dopcik-Smith ND, Hay SN, Brecher ME. Bacterial contamination of blood products: factors, options, and insights. J Clin Apher 2001; 16:192—201.Dopcik-Smith ND, Hay SN, Brecher ME. Bacterial contamination of blood products: factors, options, and insights. J Clin Apher 2001; 16:192—201.Morel P, Leconte des Floris MF, Bardiaux L et al. Transfusion du sang et risk bacterial. Transfus Clin Biol 2000; 7:15—23.Morel P, Leconte des Floris MF, Bardiaux L et al. Transfusion du sang et risk bacterial. Transfus Clin Biol 2000; 7:15—23.Reading FC, Brecher ME. Transfusion-related bacterial sepsis. Curr Opin Hematol 2001; 8:380—386.Reading FC, Brecher ME. Transfusion-related bacterial sepsis. Curr Opin Hematol 2001; 8:380—386.Sugai Y, Sugai K, Fuse A. Current status of bacterial contamination of autologous blood for transfusion. Transfus Apher Sci 2001; 24:255—259.Sugai Y, Sugai K, Fuse A. Current status of bacterial contamination of autologous blood for transfusion. Transfus Apher Sci 2001; 24:255—259.Wagner SJ. Transfusion-transmitted bacterial infection: risk, sources, and interventions. Vox Sang 2004; 86:157—163.Wagner SJ. Transfusion-transmitted bacterial infection: risk, sources, and interventions. Vox Sang 2004; 86:157—163.Ishida T, Nakano K, Nakatani H et al. Is open heart surgery clean: bacteriologic analysis of salvaged blood. Kyobu Geka 2001; 54:207—210.Ishida T, Nakano K, Nakatani H et al. Is open heart surgery clean: bacteriologic analysis of salvaged blood. Kyobu Geka 2001; 54:207—210.Ishida T, Nakano S, Nakatani H et al. Bacterial contamination of salvaged blood in open heart surgery: is that an airborne contamination or a normal skin flora contamination? Kyobu Geka 2001; 54:753—757.Ishida T, Nakano S, Nakatani H et al. Bacterial contamination of salvaged blood in open heart surgery: is that an airborne contamination or a normal skin flora contamination? Kyobu Geka 2001; 54:753—757.Wang G, Bainbridge D, Pharm JM et al. The efficacy of an intraoperative cell-saver during cardiac surgery: A meta-analysis of randomized trials. Anesth Analg 2009; 109:320—323. doi:10.1213/ane.0b013e3181aa084c.Wang G, Bainbridge D, Pharm JM et al. The efficacy of an intraoperative cell-saver during cardiac surgery: A meta-analysis of randomized trials. Anesth Analg 2009; 109:320—323. doi:10.1213/ane.0b013e3181aa084c.Bland LA, Villarino ME, Arduino MJ et al. Bacteriologic and endotoxin analysis of salvaged blood used in autologous transfusions during cardiac operations. J Thorac Cardiovasc Surg 1992; 103:582—588.Bland LA, Villarino ME, Arduino MJ et al. Bacteriologic and endotoxin analysis of salvaged blood used in autologous transfusions during cardiac operations. J Thorac Cardiovasc Surg 1992; 103:582—588.Filtracco P, Michioletto S, Barbieri S et al. Microbiologic contamination of intraoperative blood salvaged during liver transplantation. Transplant Proc 2007; 39:1889—1991. doi:10.1016/j.transproceed.2007.05.005.Filtracco P, Michioletto S, Barbieri S et al. Microbiologic contamination of intraoperative blood salvaged during liver transplantation. Transplant Proc 2007; 39:1889—1991. doi:10.1016/j.transproceed.2007.05.005.Kudo H, Fujita H, Hanada Y et al. Cytological and bacteriological studies of intraoperative autologous blood in neurosurgery. Surg Neurol 2004; 62:195—199. doi:10.1016/J.surneu.2003.10.044.Kudo H, Fujita H, Hanada Y et al. Cytological and bacteriological studies of intraoperative autologous blood in neurosurgery. Surg Neurol 2004; 62:195—199. doi:10.1016/J.surneu.2003.10.044.Duffu G, Neal KR. Differences in post-operative infection rates between patients receiving autologous and allogenic blood transfusion: a metaanalysis of published randomized and nonrandomized studies. Transfus Med 1996; 6:325—328.Duffu G, Neal KR. Differences in post-operative infection rates between patients receiving autologous and allogenic blood transfusion: a metaanalysis of published randomized and nonrandomized studies. Transfus Med 1996; 6:325—328.Wasl H, McGuire JL, Lubbe D. Avoiding allogenic blood transfusion in endoscopic angiofibroma surgery. J Otolaryngol Head Neck Surg 2016; 45:25—30. doi:10.1186/s40463-016-0135-5.Wasl H, McGuire JL, Lubbe D. Avoiding allogenic blood transfusion in endoscopic angiofibroma surgery. J Otolaryngol Head Neck Surg 2016; 45:25—30. doi:10.1186/s40463-016-0135-5.Waters J, Tuohy M, Hobson D et al. Bacterial reduction by cell-saver salvage washing and leukocyte depletion filtration. Anesthesiology 2003; 99:652—655.Waters J, Tuohy M, Hobson D et al. Bacterial reduction by cell-saver salvage washing and leukocyte depletion filtration. Anesthesiology 2003; 99:652—655.Hewitt P. Bacterial contamination // In: Murphy MF, Pamphilon DH, eds. Practical Transfusion Medicine. — London: Blackwell Sci, 2001; pp. 169—174.Hewitt P. Bacterial contamination // In: Murphy MF, Pamphilon DH, eds. Practical Transfusion Medicine. — London: Blackwell Sci, 2001; pp. 169—174.Petz L. D. The surgeon and the transfusion service: Essentials of compatibility testing, surgical blood ordering, emergency blood needs, and adverse reactions // In: Spiess BD, Counts RB, Gould SA, eds. Perioperative Transfusion Medicine. — Baltimore: Williams Wilkins, 1998; pp. 45—59.Petz L. D. The surgeon and the transfusion service: Essentials of compatibility testing, surgical blood ordering, emergency blood needs, and adverse reactions // In: Spiess BD, Counts RB, Gould SA, eds. Perioperative Transfusion Medicine. — Baltimore: Williams Wilkins, 1998; pp. 45—59.Warner MA Infectious risk of transfusion // In: Spiess BD, Counts RB, Gould SA, eds. Perioperative Transfusion Medicine. — Baltimore: Williams Wilkins, 1998; pp. 98—110.Warner MA Infectious risk of transfusion // In: Spiess BD, Counts RB, Gould SA, eds. Perioperative Transfusion Medicine. — Baltimore: Williams Wilkins, 1998; pp. 98—110.Baram N, Megged O, Weiser G. Occult bacteremia: Should we look for the needle in the haystack? Isr Med Assoc J 2016; 18:649—651.Baram N, Megged O, Weiser G. Occult bacteremia: Should we look for the needle in the haystack? Isr Med Assoc J 2016; 18:649—651.Larsen T, Fiehn NE. Dental biofilm infections — an update. APMIS 2017; 125:376—384. doi:10.1111/apm.12688.Larsen T, Fiehn NE. Dental biofilm infections — an update. APMIS 2017; 125:376—384. doi:10.1111/apm.12688.Smith D. A., Nehring S. M. Bacteremia. StatPeals [Internet]. Treasure Island (FL): StatPearls publishing, 2017:1—3.Smith D. A., Nehring S. M. Bacteremia. StatPeals [Internet]. Treasure Island (FL): StatPearls publishing, 2017:1—3.

The authors declare that there are no conflicts of interest present.