肌少症对胰十二指肠切除术后并发症影响的临床分析

Clinical analysis of the effect of sarcopenia on postoperative complications of pancreaticoduodenectomy

目的探讨肌少症对胰十二指肠切除术(pancreatoduodenectomy,PD)患者术后并发症的影响。方法回顾性分析2012年3月至2020年2月期间南京医科大学附属南京医院收治的225例行PD患者的资料,在第3腰椎水平的CT图像测量骨骼肌面积进行肌少症诊断,分为肌少症组和非肌少症组,比较2组病例的临床资料、手术并发症,探究肌少症与PD术后并发症发生的关系。结果与非肌少症组比较,肌少症组患者的年龄更大,血红蛋白和血清白蛋白水平更低,总胆红素水平更高(P<0.05);临床相关胰瘘(B、C级瘘)、肺部感染、肺不张和低氧血症的发生率更高(P<0.05);肌少症组患者住ICU时间及围手术期病死率长于或高于非肌少症组(P<0.05)。多因素分析结果显示:肌少症、术前总胆红素水平、胰管直径和胰腺质地是临床相关胰瘘的独立危险因素(P<0.05);肌少症、术中出血量和术后腹腔感染是PD术后肺部并发症的独立危险因素(P<0.05)。结论肌少症是PD术后临床相关胰瘘和肺部并发症发生率增高的独立危险因素,加强肌少症患者围手术期的营养治疗和康复锻炼,对减少PD术后并发症具有重要意义。

Objective To investigate the effect of sarcopenia on postoperative complications in patients undergoing pancreaticoduodenectomy(PD).Methods The data of 225 patients who underwent pancreaticoduodenectomy in the Nanjing Hospital Affiliated to Nanjing Medical University(Nanjing First Hospital)from March2012 to February 2020 were retrospectively analyzed.The total area of the skeletal muscle was measured by CT images at the level of the third lumbar vertebra for the diagnosis of sarcopenia.The patients were divided into sarcopenia group and non-sarcopenia group.The clinical data and surgical complications were compared between the two groups to explore the relationship between sarcopenia and postoperative complications.Results Compared with the non-sarcopenia group,the patients in the sarcopenia group were older and had lower hemoglobin concentration,lower serum albumin concentration,and higher total bilirubin levels(P<0.05).The incidences of clinically relevant pancreatic fistula(grade B and C fistula),pulmonary infection,atelectasis and hypoxemia in the sarcopenia group were significantly higher than those in the non-sarcopenia group(P<0.05).The length of ICU stay and perioperative mortality in the sarcopenia group were significantly higher than those in the non-sarcopenia group(P<0.05).Multivariate analysis showed that sarcopenia,preoperative total bilirubin level,pancreatic duct diameter and pancreatic texture were independent risk factors for clinically relevant pancreatic fistula(P<0.05).Sarcopenia,intraoperative blood loss and postoperative abdominal infection were independent risk factors for pulmonary complications after PD(P<0.05).Conclusions Sarcopenia is an independent risk factor for increased incidence of clinically relevant pancreatic fistula and pulmonary complications after PD.Strengthening perioperative nutritional therapy and rehabilitation exercise in patients with sarcopenia is of great significance to reduce postoperative complications of PD.