肝门部胆管癌患者营养不良评估与术后并发症的相关研究

Nutritional assessment patients with hilar cholangiocarcinoma and its relationship with postoperative complications

目的探讨术前肝门部胆管癌患者发生营养不良的比例,分析营养不良的相关因素及营养不良与肝门部胆管癌术后并发症的关系。方法选取山西医科大学附属人民医院普外科在2000年1月1日—2015年1月1日期间收治的可根治性切除的53例肝门部胆管癌患者,术前根据患者主观营养评估法(PG-SGA)评分分为营养良好组(PG-SGA<3分)及营养不良组(PG-SGA≥4分),应用χ~2检验分析临床资料及营养不良与术后并发症之间的关系。结果通过PG-SGA营养评估,29例(54.7%)肝门部胆管癌患者术前存在营养不良,其发生营养不良与年龄、黄疸持续时间、^(13)C-美沙西丁呼气试验肝功能分级和TNM分期等因素有关,P均<0.05;而与患者性别、肿瘤Bismuth-Corlett分型、BMI、术前白蛋白、肝功能Child分级等因素无关,P均>0.05。术前存在营养不良未能进行营养治疗组术后并发症的发生率显著高于营养良好组,差异有统计学意义(χ~2=4.201,P=0.040),而术前存在营养不良同时进行营养治疗组术后并发症的发生率与营养良好组差异无统计学意义(χ~2=0.438,P=0.508)。结论肝门部胆管癌患者中术前发生营养不良的比例极高,对营养不良患者围手术期给予营养治疗能够有效降低术后并发症的发生率。

Objective To investigate the proportion of malnutrition in patients with hilar cholangiocarcinoma（ HC）,and analyze the factors associated with the malnutrition and the influence of malnutrition to postoperative complications. Methods Total 53 cases of hilar cholangiocarcinoma met the criterion of radical excision in our hospital between January,2000 and January,2015 were enrolled into this study and the clinic date were reviewed. All of them were assigned into well nutrition group and malnutrition group according to the scored patient-generated subjective global assessment（ PG-SGA）.The relationship between the malnutrition and postoperative complications were evaluated. Results According to PGSGA,29 cases（ 54. 7%） were with malnutrition. The factors associated with malnutrition includedage,duration of jaundice,liver function classification by-（13）C-methacetin breath test and stage of tumor（ P〈0. 05 respectively）,but not with gender,Bismuth- Corletttyping,BMI,preoperative albumin level and Child Pugh Score（ P〈0. 05）. The incidence of postoperativecomplications was higher in malnutrition group that did not receiving nutrition innervation than that in well nutrition group（ χ-2= 4. 201,P = 0. 040）. There were no obvious differences in the incidence of postoperative complications between the malnutrition group that receive nutritional support and the well nutrition group（ χ-2= 0. 438,P = 0. 508）. Conclusion The incidence of malnutrition is commonin patients with hilar cholangiocarcinoma before the surgery treatment,and perioperative nutritional support may reduce postoperative complications.