营养状态和肥胖与根治性膀胱切除术后的早期并发症和死亡风险的相关性

The association of nutritional status and obesity with early complications and mortality risk after radical cystectomy

目的探讨营养状态和肥胖对根治性膀胱切除术后早期并发症的发生及预后的影响。方法回顾性分析2014年1月至2017年3月上海交通大学医学院附属同仁医院泌尿外科因膀胱癌行根治性膀胱切除术的84例患者的一般营养状况及手术资料。分析营养因素与术后90 d内并发症发生的关系,应用多因素Cox回归分析随访1年不良预后的危险因素。结果并发症组在美国麻醉医师协会分级、术后住院时间、手术时间方面与无并发症组比较差异有统计学意义(P<0.05),并发症组术前血红蛋白、白蛋白均低于无并发症组(P<0.05),术前6个月体重下降情况较无并发症组更严重(P<0.05),术前体质指数(BMI)高于无并发症组(P<0.05)。多因素Cox回归分析发现低白蛋白、BMI以及手术时间是术后1年死亡的独立危险因素(P<0.05)。结论低白蛋白和BMI是根治性膀胱切除术后死亡的独立危险因素,应重视患者术前营养状态,积极改善预后。

Objective To investigate the association of nutritional status and obesity with the early complications and prognosis after radical cystectomy.Methods The clinical data of 84 patients undergoing radical cystectomy for bladder cancer during Jan.2014 and Mar.2017 were retrospectively analyzed,including the general nutrition data and surgical information.The association of 90-day postoperative complications and nutritional status was analyzed.The risk factors of 1-year poor prognosis were analyzed with multivariate Cox regression.Results There were significant differences in ASA classification,hospital stay and operation time between the complication group and non-complication group(P<0.05).The preoperative levels of hemoglobin and albumin were lower in the complication group than in the non-complication group(P<0.05);the preoperative weight loss was more serious in the complication group(P<0.05);body mass index(BMI)was larger in the complication group(P<0.05).Multivariate Cox regression analysis showed that hypoalbuminemia,BMI and operation time were independent risk factors for death 1 year after operation(P<0.05).Conclusion Hypoalbuminemia and BMI are independent risk factors for mortality after radical cystectomy.Due attention should be paid to the nutritious status of patients to improve the prognosis.