肌少症与胰十二指肠切除术后患者结局的关系

The relationship of sarcopenia in patients undergoing pancreaticoduodenectomy with outcome

目的探讨肌少症与胰十二指肠切除术后患者预后的关系。方法收集2011年3月至2016年8月就诊于武汉大学人民医院行胰十二指肠切除术的116例患者的并发症及生存率随访资料，并进行统计学分析。结果116例患者中，肌少症49例（42．2％）。肌少症组患者术后发生并发症的概率较非肌少症组显著增加（所有并发症：59．2％比38．8％，χ2=4．714，P=0．030；Clavien-DindoⅢ级及以上：26．5％比10．4％，χ2=5．130，P=0．024），术后恢复时间较非肌少症组显著延长[（17．33±6．54）d比（13．46±9．32）d，P=0．013]。Kaplan-Meier生存分析结果显示，肌少症是患者术后总生存率及无复发生存率显著降低的危险因素（P〈0．05）。Cox比例风险模型分析结果显示，肌少症是术后总生存率及无复发生存率降低的危险因素（总生存率：风险比=2．285，95％CI=1．521-3．431；无复发生存率：风险比=2．167，95％CI=1．445～3．248）。结论肌少症是胰十二指肠切除术后患者预后不佳的危险因素，合并肌少症的患者不仅术后并发症发生的概率增加，总生存率及无复发生存率也显著下降。

Objective To explore the prognostic value of sarcopenia in patients undergoing pancreati- coduodenectomy. Method Clinieopathologic data and follow-up information of 116 patients undergoing pancre- aticoduodenectomy at Renmin Hospital of Wuhan University between March 2011 and August 2016 were collect- ed for statistical analysis. Results Among the 116 patients, the prevalence of sarcopenia was 42. 2% （ n = 49）. When compared to the rest of the patients who did not have sarcopenia, the sarcopenia group had longer recov- ery time [ （ 17.33±6. 54） d vs. （ 13.46±9. 32） d, P=0. 013] and increased risk of complications （ complica- tions in general, 59. 2% vs. 38. 8%, χ2 = 4. 714, P = 0. 030; Clavien-Dindo ≥ 3 ： 26. 5% vs. 10. 4%,χ2 = 5. 130, P = 0. 024）. Both the Kaplan-Meier survival analysis （P〈0. 05） and the Cox proportional hazard model （ overall survival ： hazard ratio = 2. 285, 95% CI = 1. 521 - 3.431 ; recurrence-free survival, hazard ratio = 2. 167, 95% CI= 1. 445-3. 248） indicated sarcopenia as the risk factor for poorer overall survival and recur- rence-free survival. Conclusions Sarcopenia was an independent predictor of poor prognosis for patients under- going pancreaticoduodenectomy. Patients with sarcopenia had higher risk of developing complications after sur- gery and lower overall survival rate and recurrence-free survival rate.