新辅助化疗联合营养支持降低结直肠癌伴不全梗阻患者术后腹部并发症的研究  

Neoadjuvant chemotherapy combined with nutritional support reduces postoperative abdominal complications in colorectal cancer patients with incomplete obstruction

作　　者：朱文强 吴震峰 曹勤洪 陈志伟 吴晓宇 陈彻 许哲 李为苏 姚学权 刘福坤 ZHU Wenqiang;WU Zhenfeng;CAO Qinhong;CHEN Zhiwei;WU Xiaoyu;CHEN Che;XU Zhe;LI Weisu;YAO Xuequan;LIU Fukun(Department of Surgical Oncology,the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China)

机构地区：[1]南京中医药大学附属医院(江苏省中医院)消化肿瘤外科,江苏南京210029

出　　处：《中国肿瘤外科杂志》2018年第5期287-290,295,共5页Chinese Journal of Surgical Oncology

摘　　要：目的探讨结直肠癌伴不全梗阻患者营养支持的同时行新辅助化疗的可行性,并观察新辅助化疗联合营养支持对患者术后腹部并发症发生率的影响。方法选择2011年8月至2016年1月期间在南京中医药大学附属医院接受诊治的139例结直肠癌伴不全梗阻患者为研究对象,其中接受新辅助化疗87例,拒绝新辅助化疗52例。比较两组术后腹部并发症发生率,并分析术后腹部并发症的影响因素。结果接受新辅助化疗87例患者均完成2个疗程的新辅助化疗,营养状况较前明显好转,梗阻评分均有不同程度升高。术后腹部并发症发生率11.5%(10/87);拒绝新辅助化疗52例患者,术后腹部并发症发生率30.8%(16/52)。logistic单因素方差分析示:美国麻醉医师协会(ASA)分级、营养风险筛查评分量表2002(NRS2002)评分、术前梗阻评分、新辅助化疗、联合脏器切除与术后腹部并发症发生率有关。多因素回归分析:NRS2002评分、联合脏器切除是术后腹部并发症发生率的独立危险因素;术前梗阻评分、新辅助化疗是术后腹部并发症发生率的保护因素。结论结直肠癌伴不全梗阻患者的肿瘤分期均为进展期,新辅助化疗联合营养支持能够改善此类患者的营养状况、减轻梗阻程度,进而降低术后腹部并发症发生率。Objective To investigate the feasibility of neoadjuvant chemotherapy（NACT） for nutritional support of colorectal cancer patients with incomplete obstruction,and to observe the effect of NACT and nutritional support on the incidence of postoperative abdominal complications.Methods Clinical date of 139 colorectal cancer patients with incomplete obstruction treated in the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from August 2011 to January 2016 were retrospectively analyzed,87 cases received NACT,otherwise 52 cases refused to NACT.Differences in the incidence of postoperative abdominal complications were compared between the NACT group and the non-NACT groups.Results All 87 patients completed 2 courses of NACT,whose nutritional status were significantly improved,and whose scores of obstruction were increased in different degrees.The incidence of postoperative abdominal complications was11.5%（10/87） in patients who underwent NACT,whereas the incidence of postoperative abdominal complications was 30.8%（16/52） who refused NACT.Single factor analysis indicated that ASA（American Anesthesiologists Association） classification,NRS2002（Nutrition Screening 2002） score,preoperative obstruction score,NACT,combined organ resection were related to the incidence of postoperative abdominal complications;Multivariate analysis revealed that NRS2002 and combined organ resection were independent risk factors for postoperative abdominal complications.Preoperative obstruction score and NACT were protective factors of postoperative abdominal complications.Conclusions The stage of tumor in all colorectal cancer patients with incomplete obstruction is advanced.NACT combined with nutritional support can improve nutritional status,reduce the degree of obstruction,and then reduce the incidence of postoperative abdominal complications of these patients.

关 键 词：结直肠肿瘤 肠梗阻 新辅助化疗 营养支持 手术后并发症 

分 类 号：R735.34[医药卫生—肿瘤]