基于CT诊断的肌少症对结直肠癌患者发生手术部位感染的影响因素分析  

Association of CT-assessed Sarcopenia with Postoperative Surgical Site Infections in Patients with Colorectal Cancer

作　　者：张芳芳 胡雅静 黄华勇 倪锦晖 尤泽 常巧玲 廖力[1] ZHANG Fangfang;HU Yajing;HUANG Huayong;NI Jinhui;YOU Ze;CHANG Qiaoling;LIAO Li(School of Nursing,University of South China,Hengyang 421001,China;Department of Emergency Medicine,the First Affiliated Hospital of University of South China,Hengyang 421001,China;Operating Room,the First Affiliated Hospital of University of South China,Hengyang 421001,China)

机构地区：[1]南华大学护理学院,湖南省衡阳市421001 [2]南华大学附属第一医院急诊科,湖南省衡阳市421001 [3]南华大学附属第一医院手术室,湖南省衡阳市421001

出　　处：《中国全科医学》2022年第29期3658-3663,共6页Chinese General Practice

基　　金：湖南省社会科学成果评审委员会课题(XSP22YBZ180)。

摘　　要：背景肌少症是一种骨骼肌质量和总量进行性和全面性丧失的综合征,可以增加结直肠癌术后并发症的风险,但对于手术部位感染的影响目前尚未定论。目的评估基于腹部计算机断层扫描(CT)诊断的肌少症对结直肠癌手术患者手术部位感染的影响。方法回顾性收集2019年7月至2021年12月在南华大学附属第一医院胃肠外科接受根治性结直肠癌切除术328例患者的临床资料,通过医院电子病历查询系统收集患者的信息。根据腹部CT结果计算的第三腰椎骨骼肌肌肉质量指数,将患者分为肌少症组(n=44)和非肌少症组(n=284),参照《医院感染诊断标准》评估患者手术部位感染发生情况。采用多因素Logistic回归分析探讨结直肠癌患者术后发生手术部位感染的影响因素。结果肌少症组手术部位感染发生率〔12(27.3%)〕高于非肌少症组〔35(12.3%)〕(P<0.05)。多因素Logistic回归分析结果显示,肌少症〔OR=2.659,95%CI(1.221,5.791),P=0.014〕、美国麻醉师协会(ASA)分级≥3级〔OR=2.192,95%CI(1.140,4.216),P=0.019〕、肠造口〔OR=2.222,95%CI(1.160,4.257),P=0.016〕是结直肠癌术后发生手术部位感染的危险因素。结论合并肌少症是结直肠癌术后发生手术部位感染的危险因素,在手术前筛查结直肠癌患者是否存在肌少症,并采取相关措施与功能锻炼,有利于改善患者预后。Background Sarcopenia,a syndrome of progressive and generalised loss of skeletal muscle,which can increase the risk of postoperative complications of colorectal cancer,but its association with postoperative surgical site infections in colorectal cancer is still inconclusive.Objective To evaluate the association of abdominal CT-assessed sarcopenia with postoperative surgical site infections in patients undergoing colorectal cancer surgery.Methods Three hundred and twenty-eight colorectal cancer patients underwent radical surgery in Gastrointestinal Surgery,the First Affiliated Hospital of University of South China between July 2019 and December 2021 were selected.Clinical data were retrospectively collected through the electronic medical record system.Sarcopenia was diagnosed by the L3 skeletal muscle index(L3 SMI)assessed using abdominal CT.Surgical site infection was assessed using the Diagnostic Criteria of Nosocomial Infection(Trial).Multivariate Logistic regression was applied to explore the influencing factors of postoperative surgical site infection.Results The incidence of surgical site infection in sarcopenia group was higher than that in non-sarcopenia group〔27.3%(12/44)vs 12.3%(35/284)〕(P<0.05).Multivariate Logistic regression analysis showed that sarcopenia〔OR=2.659,95%CI(1.221,5.791),P=0.014〕,ASA classⅢor greater〔OR=2.192,95%CI(1.140,4.216),P=0.019〕and enterostomy〔OR=2.222,95%CI(1.160,4.257),P=0.016〕influenced postoperative surgical site infection in colorectal cancer.Conclusion Sarcopenia may be a risk factor for postoperative surgical site infection in colorectal cancer patients.To improve the prognosis of colorectal cancer patients,preoperative screening for sarcopenia should be performed,interventions should timely given to those with sarcopenia,and these patients should take functional exercises following the advice of medical workers.

关 键 词：肌少症 结直肠肿瘤 外科伤口感染 手术后并发症 影响因素分析 

分 类 号：R735.34[医药卫生—肿瘤]