术前CT图像评估人体成分在预测胰腺癌术后并发症中的价值

Value of preoperative body composition analysis through computed tomography scanning images in predicting postoperative complications of patients undergoing radical pancreatectomy

目的探讨术前CT图像评估人体成分在预测胰腺癌根治术后并发症中的价值。方法回顾性分析2018年1月至2021年1月在南京大学医学院附属鼓楼医院胰腺外科行胰腺癌根治术的79例病人的临床及影像学资料。其中行胰十二指肠切除术(pancreaticoduodenectomy,PD)47例,行顺行性模块化根治性胰脾切除术(radical antegrade modular pancreatosplenectomy,RAMPS)32例。观察指标:基线指标、术式及围术期并发症发生情况、CT测量的第3腰椎层面骨骼肌及内脏脂肪的含量。结果79例病人中术前发生肌肉减少症36例(45.6%),发生内脏型肥胖23例(29.1%)。所有病人均顺利手术治疗,术后胰瘘、腹腔内感染、Clavien-DindoⅢ级及以上并发症发生率分别为13.9%(11/79)、10.1%(8/79)、6.3%(5/79)。按照手术方式亚组分析结果显示,术前伴肌肉减少症者骨骼肌指数(skeletal muscle index,SMI)、内脏脂肪面积(visceral fat area,VFA)、体质量指数(body mass index,BMI)较无肌肉减少症者低(P<0.05),但未显示与术后胰瘘、腹腔感染、Clavien-DindoⅢ级及以上并发症发生有统计学关联(P>0.05)。术前伴内脏肥胖者SMI、VFA、BMI较无内脏肥胖者高(P<0.05),但与术后腹腔感染、Clavien-DindoⅢ级及以上并发症发生无统计学关联(P>0.05);PD病人中,伴内脏肥胖者胰瘘发生率低于无内脏肥胖者(0比26.5%,P=0.039),RAMPS病人中,有无内脏肥胖者术后胰瘘发生率差异无统计学意义(P=0.534)。结论术前CT图像可较准确判断病人人体成分组成,可作为术前营养状况评估的参考指标,术前伴肌肉减少症及内脏肥胖与术后并发症的关系仍需大样本、多中心的研究。

Objective To assess the value of preoperative body composition analysis through computed tomography(CT)scanning images in predicting postoperative complications of radical pancreatectomy.Methods From January 2018 to January 2021,clinical data and CT images were retrospectively reviewed for 79 patients undergoing radical pancreatectomy for pancreatic carcinoma.Pancreaticoduodenectomy(n=47)and radical antegrade modular pancreatosplenectomy(n=32)were performed.Baseline parameters,surgical approaches,occurrences of postoperative complications and contents of skeleton muscle and visceral fat at the level of L_(3) on CT images were recorded.Results Rates of preoperative sarcopenia and visceral obesity were 45.6%(36/79)and 29.1%(23/79).All procedures of radical pancreatectomy were all successfully performed.The incidence of postoperative pancreatic fistula,abdominal infection and complications above Clavien-Dindo Ⅲ was 13.9%(11/79),10.1%(8/79)and 6.3%(5/79)respectively.Subgroup analysis based upon procedures indicated SMI,VFA and BMI were lower in sarcopenia group and higher in visceral obesity group(P<0.05).Incidence of pancreatic fistula,abdominal infection and major complication did not differed in patients with or without sarcopenia(P>0.05).Between with or without visceral obesity occurrence of abdominal infection and major complication(P>0.05).Pancreatic fistula was more common in non-visceral obesity group for patients underwent PD(0 vs.26.5%,P=0.039)while no difference was observed in RAMPS group(P=0.534).Conclusion Analyzing preoperative CT images may evaluate body composition and nutrition status effectively.It shows no correlation with the occurrence of postoperative complications after radical pancreatectomy.Further multi-center and high volume studies were needed.