术前营养风险与直肠癌前切除术后吻合口漏的相关性分析

Correlation Analysis of Preoperative Nutritional Risk and Anastomotic Leakage Following Anterior Resection for Rectal Cancer

目的探讨术前营养风险评估与直肠癌前切除术后吻合口漏的相关性。方法回顾性分析2008年1月至2013年12月期间笔者所在医院321例行直肠癌前切除术患者的临床资料,采用营养风险筛查2002（NRS 2002）对入组患者术前营养风险进行评分,并通过单因素分析和多因素Logistic回归模型分析术前营养风险与术后吻合口漏的相关性。结果 321例患者术后吻合口漏发生率为5.6%（18/321）。单因素分析结果显示,NRS2002评分≥3分、临床病理分期为Ⅲ-Ⅳ期以及吻合口距肛缘距离≤5 cm是吻合口漏的危险因素（P〈0.01）;多因素Logistic回归分析结果显示,NRS2002评分（OR=4.125,95%CI=2.062～7.004）、临床病理分期（OR=3.334,95%CI=2.062～7.004）及吻合口距肛缘距离（OR=2.341,95%CI=2.559～15.838）是吻合口漏的独立危险因素。结论直肠癌前切除术患者术前NRS2002评分有助于预测术后吻合口漏发生风险,对于NRS2002评分≥3分的患者,应加强围手术期营养支持。

Objective To investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer. Methods A total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model. Results Among the 321 patients, the incidence of postoperative anastomotic leakage was 5.6%（18/321）. Single factor analysis showed that the NRS2002 score ≥3, clinicalpathologic stage（Ⅲ-Ⅳ stage） and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score（OR=4.125, 95%CI=2.062-7.004）, clinicalpathologic stage（OR=3.334, 95%CI= 2.062-7.004） and the distance of tumor from the anal verge（OR=2.341, 95%CI= 2.559-15.838） were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conclusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who＇s NRS2002 score ≥3.