术前伴肌少症的食管癌患者临床特点和术后并发症的影响因素分析

Clinical Characteristics of Esophageal Cancer Patients with Sarcopenia Preoperatively and Influencing Factors of Postoperative Complications

目的探讨术前伴肌少症(SA)的食管癌患者临床特点和术后并发症的影响因素。方法选取2017年1月至2020年12月于河南中医药大学第一附属医院胸外科接受McKeown-MIE的140例食管癌患者作为研究对象,基于术前8触极多频生物电阻抗人体成分分析结果将患者分为肌少症组(SA组,58例)和非肌少症组(NSA组,82例),比较两组患者围手术期及术后临床特点的差异,分析术前伴SA的食管癌患者术后并发症的影响因素。结果SA组患者年龄高于NSA组(P<0.05),而体质量指数(BMI)、机体功能状态评分(KPS)及第1秒用力呼气容积(FEV_(1))低于NSA组(P<0.05)。SA组患者术后肺炎、心律失常、总体并发症发生率及Clavien-Dindo外科手术并发症分级均高于NSA组(P<0.05),且术后住院时间长于NSA组(P<0.05)。两组患者术前生命质量(QOL)评分及各条目评分比较,差异无统计学意义(P>0.05);术后第2~8周,SA组患者总体QOL评分、躯体功能评分、角色功能评分及社会功能评分均低于NSA组(P<0.05)。logistic单因素回归分析显示食管癌患者术后并发症与SA(OR=2.317,P<0.001)、年龄(OR=1.393,P=0.012)、BMI(OR=0.654,P<0.001)及FEV_(1)(OR=0.561,P=0.033)相关。logistic多因素回归分析显示SA(OR=1.891,P<0.001)、BMI降低(OR=0.559,P<0.001)是食管癌患者发生术后并发症的独立危险因素。结论术前伴SA的食管癌患者总体身体功能较差,导致术后短期内生命质量下降,术前SA是食管癌患者McKeown-MIE后并发症的独立危险预测因子。

Objective To investigate the clinical characteristics of esophageal cancer patients with preoperative sarcopenia(SA)and the influencing factors of postoperative complications.Methods A total of 140 patients with esophageal cancer who underwent McKeown-Mie in thoracic surgery department in the First Affiliated Hospital of Henan University of Chinese Medicine from January 2017 to December 2020 were selected as the research objects.Based on the results of 8-touch multifrequency bioelectrical impedance analysis before operation,the patients were divided into sarcopenia group(SA group,58 cases)and non sarcopenia group(NSA group,82 cases).The differences of perioperative and postoperative clinical characteristics of patients of the two groups were compared,and the influencing factors of postoperative complications in patients with esophageal cancer with SA before operation were analyzed.Results The age of SA group was higher than that of NSA group,while the body mass index(BMI),karnofsky Performance Status(KPS)and forced expiratory volume in 1 second(FEV_(1))of SA group were significantly lower than those of NSA group(P<0.05).The incidence rate of overall postoperative complications,pneumonia and arrhythmia,and Clavien Dindo surgical complication grade of SA group were higher than those of NSA group,and postoperative hospital stay was longer than that of NSA group(P<0.05).There was no significant difference in the preoperative quality of life(QOL)score and each item score between the two groups before operation.From the second week to the eighth week after operation,the scores of the overall QOL,physical function,role function and social function of SA group were lower than those of NSA group(P<0.05).Logistic regression analysis showed that postoperative complications were closely related to SA(OR=2.317,P<0.001),age(OR=1.393,P=0.012),BMI(OR=0.654,P<0.001)and FEV_(1)(OR=0.561,P=0.033).Logistic regression analysis showed that SA(OR=1.891,P<0.001)and lower BMI(OR=0.559,P<0.001)were independent risk factors for postoperative complications in patients with esophageal cancer.Conclusion Patients with esophageal cancer accompanied by SA before surgery have poor overall physical function,leading to worse quality of life in the short term after surgery,and SA before surgery is an independent risk factor for complications after McKeown-Mie in patients with esophageal cancer.