预后营养指数与结直肠癌伴急性肠穿孔一期切除并吻合后预后的相关性研究

Prognostic nutritional index associates with the prognoses of colorectal cancer with acute bowel perforation after primary resection and anastomosis

目的探讨预后营养指数(predictive nutritional index,PNI)能否通过术前营养和炎症状态预测结直肠癌伴急性肠穿孔病人的术后并发症及5年总生存率和无复发生存率。方法回顾性分析2012年12月至2018年6月在北京朝阳医院普通外科住院的结直肠癌伴急性肠穿孔病例,其中接受根治性结直肠切除术并一期吻合者57例。统计病人的临床病理资料、术前PNI、术后并发症、术后生存及复发情况等;采用受试者操作特征曲线计算出病人的术前PNI截断值;采用logistic回归分析病人的PNI与术后并发症的相关性;采用Kaplan-Meier曲线分析病人的5年总生存期和无复发生存期。结果结直肠癌伴急性肠穿孔病人的术前PNI截断值为32。低PNI组相对于高PNI组病人的年龄更大(P=0.0285)、ASAⅢ~Ⅳ级者更多(P=0.0147)、T_(4)分期者更多(P=0.0281),而且术后吻合口漏发生率更高(P=0.0314)、30 d死亡率更高(P=0.0303)以及住院时间更长(P=0.0242)。多因素分析表明低PNI是结直肠癌伴急性肠穿孔病人发生吻合口漏(OR=1.63,95%CI:1.56–3.82,P=0.0308)的危险因素,但是PNI与病人的5年总生存率和无复发生存率没有相关性。结论术前PNI<32与结直肠癌伴急性肠穿孔病人根治性切除并一期吻合术后的吻合口漏发生率增加、30 d死亡率升高以及住院时间延长有关。

Objective To explore the correlation between preoperative prognostic nutritional index(PNI)with postoperative complications and survival of colorectal cancer(CRC)patients with acute bowel perforation(ABP).Methods From December 2012 to June 2018,the relevant clinical data were retrospectively reviewed for 57 CRC patients with ABP undergoing curative resection and primary anastomosis.The clinicopathological profiles,nutritional status,postoperative complications,5-year overall survival(OS)and recurrence-free survival(RFS)were recorded.The cut-off value of preoperative PNI was calculated by receiver operating characteristic(ROC)curve.The association of PNI with postoperative complications was examined by Logistic regression.And 5-year OS/RFS was analyzed by Kaplan-Meier method.Results The optimal cut-off value of PNI was 32.PNI-low group had more elders(P=0.0285),more ASA gradeⅢ-Ⅳ(P=0.0147)and more T_(4) stage(P=0.0281)as compared with PNI-high group.Moreover,low PNI was associated with greater anastomotic leakage(P=0.0314),higher 30-day mortality(P=0.0303)and prolonged hospitalization stay(P=0.0242).Further multivariate analysis indicated that low PNI was a risk factor of anastomotic leakage(OR=1.63,95%CI:1.56–3.82,P=0.0308).However,PNI was not associated with 5-year OS/RFS in CRC patients with ABP.Conclusion In CRC patients with ABP,preoperative low PNI(<32)is a clinical predictor of anastomotic leakage,greater 30-day mortality and longer hospitalization stay after primary resection and anastomosis.