营养风险对腹腔镜辅助胃癌根治术后短期临床疗效的影响

Impact of nutritional risk on short-term clinical outcomes after laparoscope-assisted radical gastrectomy for gastric cancer

目的探讨营养风险对腹腔镜辅助胃癌根治术后短期临床疗效的影响。方法采用回顾性病例对照研究方法。收集2014年6月至2016年4月温州医科大学附属第一医院收治的150例限期行腹腔镜辅助胃癌根治术患者的临床资料。根据营养风险评分2002（NRS2002），评分≥3分为存在营养风险。150例患者中，42例存在营养风险的患者设为营养风险组，108例无营养风险患者设为无营养风险组。根据肿瘤位置分别行腹腔镜辅助远端胃大部切除术或全胃切除术。观察指标：（1）术后短期临床疗效：包括术后并发症、术后住院时间、住院费用、出院后30d内非计划性再人院。术后并发症是指术后30d内发生的并发症总数，并发症分级依据Clavien．Dindo分级分为Ⅰ～Ⅴ级，本研究只分析Ⅱ级以上并发症。（2）术后影响患者并发症发生的危险因素分析。正态分布的计量资料以互±s表示，采用独立样本t检验；偏态分布的计量资料以M（Qn）表示，使用Mann—WhitneyU检验。分类变量以具体数字和百分比描述，采用x^2检验。等级资料采用Mann—WhitneyU检验。单因素分析采用x^2检验；将单因素分析中P〈0．1的因素纳入多因素分析，多因素分析采用逐步向前条件法建立Logistic回归模型。结果（1）术后短期临床疗效：营养风险组和无营养风险组患者发生总并发症分别为9例和16例、严重并发症分别为2例和3例、术后住院时间分别为11d（9d，16d）和11d（9d，13d）、住院费用分别为57825元（51894元，66908元）和55067元（49395元，62423元）、出院30d内非计划性再入院患者例数分别为2例和8例，两组患者上述指标比较，差异均无统计学意义（x^2=0．952，0．010，Z=-1．133，-1.691，x^2=0．048，P〉0．05）。单因素分析结果显示：年龄是影响腹腔镜辅助胃癌根治术后并发症发生的危险因素（x^2=4．468，P〈0．05）。多因素分析结果显示：术前低蛋白血症是影响腹腔镜辅助胃癌根治术后并发症发生的独立危险因素（OR=2．797，95％可信区间：1．053～7．435，P〈0．05）。结论营养风险对腹腔镜辅助胃癌根治术后短期临床疗效的不良影响小，术前低蛋白血症是术后发生Ⅱ级以上并发症的独立危险因素。

Objective：To explore the impact of nutritional risk on shortterm clinical outcomes after laparoscopeassisted radical gastrectomy for gastric cancer. Methods：The retrospective casecontrol study was conducted. The clinical data of 150 patients who underwent laparoscopic gastrectomy at the First Affiliated Hospital of Wenzhou Medical University between June 2014 and April 2016 were collected. According to nutritional risk screening 2002 （NRS 2002）, 42 and 108 patients were respectively divided into the nutritional risk group （NRS 2002 score ≥3） and nonnutritional risk group （NRS 2002 score 〈3）. Laparoscopeassisted radical subtotal gastrectomy or total gastrectomy was performed based on tumor location. Observation indicators： （1） postoperative shortterm clinical outcomes： postoperative complications, duration of postoperative hospital stay, hospital expenses, unplanned readmission within 30 days after discharging. Postoperative complications meant total complications within 30 days postoperatively, grade Ⅰ-Ⅴ of ClavienDindo grade was complication classification. Grade Ⅱ and above of ClavienDindo grade were analyzed in this research. （2） Risk factors analysis affecting occurrence of postoperative complications of patients. Measurement data with normal distribution were represented as ±s and analyzed using the independentsample t test. Measurement data with skewed distribution were described as M （Qn） and analyzed using the MannWhitney U test. Categorical variables were described as number and percentage and analyzed by the chisquare test. Ranked data were analyzed by the MannWhitney U test. Univariate analysis was done by the chisquare test. P〈0.1 of univariate analysis was used to multivariate analysis. COX regression model in multivariate analysis was built using progressive condition method. Results：（1） Postoperative shortterm clinical outcomes： number of patients with total complications, number of patients with severe complications, duration of postoperative hospital stay, hospital expenses and number of patients with unplanned readmission within 30 days after discharging were 9, 2, 11 days （9 days, 16 days）, 57 825 yuan （51 894 yuan, 66 908 yuan）, 2 in the nutritional risk group and 16, 3, 11 days （9 days, 13 days）, 55 067 yuan （49 395 yuan, 62 423 yuan）, 8 in the nonnutritional risk group, respectively, with no statistically significant difference between the 2 groups （x2=0.952, 0.010, Z=-1.133, -1.691, x^2=0.048, P〉0.05）. Results of univariate analysis showed that age was a risk factor affecting incidence of complications after laparoscopeassisted radical gastrectomy for gastric cancer （x^2=4.468, P〈0.05）. Results of multivariate analysis showed that preoperative hypoproteinemia was an independent risk factor affecting incidence of complications after laparoscopeassisted radical gastrectomy for gastric cancer （OR=2.797, 95% confidence interval： 1.053-7.435, P〈0.05）. Conclusion：There is little poor impact of nutritional risk on shortterm outcomes after laparoscopeassisted radical gastrectomy for gastric cancer, preoperative hypoproteinemia is an independent risk factor affecting occurrence of grade Ⅱ and above of postoperative complications.