肌肉减少症对接受急诊手术的75岁及以上老年结直肠癌患者术后恢复及并发症的影响  

Impact of sarcopenia on postoperative recovery and complications in patients with colorectal cancer aged 75 years and older who underwent emergency operation

作　　者：梁中林[1] 杜鹏[1] 傅佶泓[1] Liang Zhonglin;Du Peng;Fu Jihong(Departments of Colorectal Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院结直肠外科,上海200092

出　　处：《结直肠肛门外科》2022年第3期249-254,共6页Journal of Colorectal & Anal Surgery

基　　金：新华医院院级临床支撑培育项目(21XHDB05)。

摘　　要：目的探讨肌肉减少症对接受急诊手术的75岁及以上老年结直肠癌患者术后恢复及并发症的影响。方法回顾性分析2015-2020年我院收治的因结直肠癌接受急诊肠道原发肿瘤切除手术的98例75岁及以上老年患者的临床资料,基于腹部CT影像计算患者的腰大肌指数,以男性低于5.24 cm^(2)/m^(2)、女性低于3.85 cm^(2)/m^(2)诊断为肌肉减少症。分析研究对象中肌肉减少症的发生率,并根据有无合并肌肉减少症将患者分为肌肉减少症组与非肌肉减少症组,记录两组一般资料及手术相关资料。结果共52例患者被诊断为肌肉减少症,肌肉减少症发生率为53.1%。两组性别、年龄、术前血红蛋白水平、术前白蛋白水平、术前ASA分级、肿瘤位置、急诊手术指征、手术方式、术后病理TNM分期比较差异均无统计学意义(均P>0.05)。共有49例患者术后入外科重症监护室(SICU),待气管插管拔除,呼吸、循环稳定后转回普通病房。两组术后入SICU患者比例及SICU住院时间比较差异均无统计学意义(均P>0.05),术中及术后输血患者比例比较差异无统计学意义(P>0.05);肌肉减少症组中位术后住院时间长于非肌肉减少症组(P<0.05)。肌肉减少症组术后总体并发症发生率及术后手术部位感染的发生率均高于非肌肉减少症组(均P<0.05)。两组术后肠梗阻、吻合口漏及腹腔出血发生率比较差异均无统计学意义(均P>0.05)。共发生Clavien-DindoⅢ级及以上严重并发症20例,其中肌肉减少症组15例、非肌肉减少症组5例,肌肉减少症组严重并发症发生率高于非肌肉减少症组(P<0.05),两组住院期间死亡率比较差异无统计学意义(P>0.05)。结论应用CT评估腰大肌指数是一种简单易行的诊断肌肉减少症的指标。肌肉减少症在接受急诊手术的75岁及以上老年结直肠癌患者中发生率较高,其对此类患者急诊手术术后恢复及并发症的发生有影响。Objectives To investigate the impact of sarcopenia on postoperative recovery and complications in patients with colorectal cancer aged 75 years and older who underwent emergency operation.Methods This was a retrospective analysis of 98 patients with colorectal cancer aged 75 years and older treated at our hospital between 2015 and 2020 with emergency intestinal tumor resection.The total psoas index was calculated based on the abdominal computed tomography(CT)scans.Sarcopenia was defined as the total psoas index of less than 5.24 cm^(2)/m^(2) in males and less than 3.85 cm^(2)/m^(2) in females.The prevalence of sarcopenia was determined.Depending on the presence of sarcopenia,patients were divided into the sarcopenia group and the normal group.Patients’characteristics and surgical details were compared between the two groups.Results Fifty-two patients were diagnosed with sarcopenia,with an overall prevalence of 53.1%.The two groups did not differ significantly in sex,age,preoperative hemoglobin level,preoperative albumin level,preoperative American Society of Anesthesiologists grade,tumor location,indications for emergency surgery,surgical approach,and pathological TNM staging(P>0.05).Forty-nine patients were admitted to surgical intensive care unit(SICU)and transferred to normal wards after airway extubation and resumption of normal spontaneous breathing and stable circulation.The two groups did not differ significantly in the proportion of admission to SICU,duration of SICU stay,and proportion of intra-and postoperative infusion(P>0.05).Postoperative duration of hospitalization was significantly longer in the sarcopenia group than in the normal group(P<0.05).The sarcopenia group also had a significantly higher overall incidence of complications and incidence of postoperative surgical site infection(P<0.05).The two groups did not differ significantly in the incidence of postoperative intestinal obstruction,anastomotic leakage,and abdominal bleeding(P>0.05).In total,20 severe complications of Clavien-Dindo grade

关 键 词：肌肉减少症 结直肠癌 老年患者 术后恢复 术后并发症 

分 类 号：R735.34[医药卫生—肿瘤]