预后营养指数与中低位直肠癌行预防性造瘘的关系

Association between the Prognosis of nutrition index and preventive stoma in middle and low rectal cancer

目的分析患者预后营养指数(PNI)与中低位直肠癌行预防性末端回肠造瘘指征的关系。方法将扬州市第一人民医院普外科2005年12月至2015年12月收治的中低位直肠癌患者378例作为研究对象。PNI值计算公式为PNI=血清白蛋白值(g/L)+5×外周血淋巴细胞总数(×109/L),分析患者临床病理特征与PNI的关系;并将研究对象分为高PNI组及低PNI组,其中高PNI组203例,低PNI组175例,比较两组吻合口瘘发生率;将低PNI组患者按照是否行预防性造瘘,分为造瘘组及未造瘘组,其中造瘘组106例,未造瘘组69例,分析两组患者吻合口瘘发生率及短期并发症发生率。结果确定高PNI组及低PNI组的分界值为43,年龄<65岁、肿瘤高中分化的中低位直肠癌患者PNI值均显著高于年龄≥65岁及肿瘤低分化的患者(P<0.05);高PNI组吻合口瘘发生率明显低于低PNI组(P<0.05);低PNI组患者中造瘘组吻合口瘘发生率、短期并发症发生率均明显低于未造瘘组(P<0.05)。结论预后营养指数是较好的术前预测病情、手术风险及预后的指标。低PNI是中低位直肠癌发生吻合口瘘的危险因素之一,对低PNI的中低位直肠癌患者行预防性造瘘可降低吻合口瘘的发生率,并降低吻合口瘘的严重程度。

Objective To analysis the association between the preoperative prognosis of nutrition index （PNI） and indication of preventive terminal ileum stoma in middle and low rectal cancer. Methods 378 mid- dle and low rectal cancer patients＇ clinical data were retrospectively analyzed in the first hospital of Yangzhou from December 2005 to December 2015. The PNI value was calculated by serum albumin（g/L） ＋ 5 ~ lympho- cytes （ × 10^9/L）, analysising the association between clinical pathological features and PNI, the patients were divided into high PNI group and the low PNI group, high PNI group including 203 patients,low PNI group inclu- ding 175 patients ,to compare the incidence of anastomotic leakage and short-term complications, low PNI groups were divided into stoma group and not stoma group according to whether preventive stoma or not, Anastomotic leakage and the short-term complication incidence were analyzed between the two groups. Results The high PNI group and the low PNI cutoff value is 43, the values of age 〈 65 ,better tumor differentiation group were sig- nificantly higher than that of control group （P 〈 0. 05 ）, the incidence of anastomotic leakage was lower in the high PNI group （P 〈 0. 05 ）. The incidence of anastomotic leakage and short-term complication was significant lower in the stoma group than the control group （ P 〈 0.05 ）. Conclusions PNI is a valuable chnical factor pre- dicting preoperative condition, surgical risk and prognosis, the low preoperative PNI value is a risk factor for low rectal cancer anastomotic leakage,preventive stoma can reduce the incidence of anastomotic leakage and the severity.