体质量指数与结直肠癌患者术后并发症的相关性分析

The association between body mass index and postoperative complications in patients with colorectal cancer

目的探讨体质量指数（BMI）与结直肠癌患者术后并发展的相关性分析。方法前瞻性收集结直肠癌患者120例，根据患者入院时BMI水平将患者分为研究组（BMI〈18．5kg／m2）和对照组（BMI≥18．5kg／m2），每组各60例？所有患者均择期行结直肠癌切除术。观察指标包括两组患者术中情况、术后并发症、术后恢复情况和术后应激反应。结果两组手术时间、淋巴结清扫数目和术中出血量等差异无统计学意义（P〉0．05）。与对照组比较，研究组术后总感染率显著增高（11．67％比1．67％，χ2=4．324，P=0．038）；并发症联合发生率显著增加（25．00％比5．00％，χ2=7．908，P=0．005）。其他并发症如切口感染、吻合口瘘、吻合口梗阻、心血管不良事件、应激性溃疡等发生率差异无统计学意义（P〉0．05）。与对照组比较，研究组术后肛门排气时间显著延长[（51．48±9．47）h比（43．73±8．63）h，t=5．382，P=0．000]；住院时间显著延长[（20．35±3．21）d比（16．28±3．48）d，t=6．462，P=0．000]。两组1年后复发率、病死率和无进展生存期等差异无统计学意义（均P〉0．05）。两组术前IL-6和CRP水平差异无统计学意义（均P〉0．05），与对照组比较，研究组术后7d时IL-6水平显著增高[（165．56±45．39）ng／L比（122．58±29．58）ng／L，t=6．459，P=0．000]；CRP水平显著升高[（23．49±8．48）mg／L比（15．37±6．53）mg／L，t=4．285，P=0．002]。结论身体体质量指数〈18．5kg／in。是结直肠癌患者术后感染、并发症的危险因素，并与患者术后应激反应增强和住院时间延长有关.

Objective To investigate the association between body mass index and postoperative complications in patients with colorectal cancer. Methods 120 patients with coloreetal cancer were prospectively studied. According to the body mass index, all patients were assigned to study group （BMI 〈 18.5kg/m2） or control group （BMI ≥ 18.5kg/m2） ,60 cases in each group. All patients received elective eoloreetal cancer resection. The operation situation, postoperative complications, postoperative recovery and postoperative stress reaction of the two groups were observed. Results There were no significant differences in the operation time, the number of lymph node dissection and the amount of bleeding between the two groups during the operation （ all P 〉 0.05 ）. Compared with the control group,the total infection rate of the study group was significantly higher（ 11.67% vs. 1.67%;χ2 = 4. 324,P = 0. 038 ） ; the incidence of postoperative complications was significantly increased （ 25.00% vs. 5.00% , χ2 = 7. 908, P = 0. 005 ）. There were no significant differences in other complications such as wound infection, anastomotic leakage, anastomotic obstruction, adverse cardiovascular events and stress ulcer （ all P 〉 0.05 ）. Compared with the control group, the postoperative anal exhaust time of the study group was significantly prolonged [ （51.48 ± 9.47 ） h vs. （43.73 ± 8.63 ）h, t = 5. 382 ,P = 0.000 ] ;and the length of hospital duration was significantly prolonged [ （20.35 ±3.21 ） d vs. （16.28 ± 3.48）d, t = 6. 462,P = 0. 000]. There were no significant differences in recurrence rate, mortality rate and progression free survival between the two groups after 1 year （all P 〉 0.05 ）. There were no significant differences in preoperative IL - 6 and CRP levels between the two groups （ all P 〉 0.05 ）. Compared with the control group, the IL -6 level of the study group at 7 - day after operation was significantly higher[ （ 165.56 ± 45.39） ng/L vs. （ 122.58 ± 29.58 ） ng/L,t = 6.459, P = 0. 000 ] ; CRP level was significantly higher[ （ 23.49 ± 8.48 ） mg/L vs.（ 15.37 ± 6.53） mg/L, t = 4.285,P = 0. 002 ]. Conclusion Body mass index less than 18.5 kg/m2 is a risk factor for postoperative infection and complications in patients with colorectal cancer, and is associated with increased stress response and prolonged hospital stay.