CT定量参数评估ESCC微创术后早期骨骼肌消耗对术后并发症的影响  

Effect of early skeletal muscle wasting estimated by CT quantitative parameters on complications after minimally invasive surgery for esophageal squamous cell carcinoma

作　　者：宋勤红 刘彩云 拾博[2] 李晓峰[2] 刘庆富[2] 渠敬明[3] SONG Qinhong;LIU Caiyun;SHI Bo(Deparment of Imaging,Huishan Hospital of Traditional Chinese Medicine,Wuxi 21400,CHINA)

机构地区：[1]无锡市惠山区中医医院影像科,江苏214000 [2]徐州市肿瘤医院影像科 [3]徐州市肿瘤医院胸外科

出　　处：《江苏医药》2022年第8期785-789,共5页Jiangsu Medical Journal

基　　金：徐州市科技局重点研发课题(KC18200);江苏大学课题(JLY20180119)。

摘　　要：目的 探讨CT定量参数评估食管鳞状细胞癌(ESCC)微创术后早期骨骼肌消耗对术后并发症的影响。方法 回顾性分析经病理证实为ESCC并接受微创食管切除术(MIE)的62例患者临床资料。采用CT测量术前基线及术后1周内腰大肌面积(L双侧横突平面),并计算腰大肌总指数(TPI)和术后早期TPI变化率(ΔTPI)。以ΔTPI中位数为截断值,分为骨骼肌轻度消耗组和重度消耗组,比较两组术后≥Ⅱ级并发症的发生率差异。采用单因素和多因素logistic回归分析ESCC患者发生术后≥Ⅱ级并发症的影响因素。结果 62例ESCC患者中,49例(79.0%)患者术后早期TPI低于术前[4.26(3.60,5.29) cm~2/m~2 vs. 4.61(3.71,5.79) cm~2/m~2](P<0.05)。将62例患者以中位ΔTPI变化率(-4.6%)分为轻度消耗组(31例)和重度消耗组(31例)。重度消耗组术后≥Ⅱ级并发症发生率高于轻度消耗组(P<0.05)。单因素及多因素logistic回归分析均显示,患者术后早期骨骼肌重度消耗、美国麻醉医师协会患者身体状况分级Ⅲ级和术前肌肉减少症是发生术后≥Ⅱ级并发症的危险因素(P<0.05)。结论 ESCC患者在MIE术后早期可发生骨骼肌重度消耗,并与术后发生≥Ⅱ级并发症相关。Objective To investigate the effect of early skeletal muscle wasting estimated by CT quantitative parameters on the complications after minimally invasive surgery for esophageal squamous cell carcinoma(ESCC).Methods The clinical data of 62 patients with ESCC confirmed by pathology underwent minimally invasive esophagectomy(MIE) were retrospectively analyzed. The area of the psoas major(Lbilateral transverse process plane) was measured by CT before and within one week after operation. The total psoas index(TPI) and the early postoperative change rate of TPI(ΔTPI) were calculated.Result Among 62 patients with ESCC,the TPI of patients in the early postoperative period was lower than that of preoperative TPI[4.26(3.60,5.29) cm~2/m~2 vs.4.61(3.71,5.79) cm~2/m~2](P<0.05). According to ΔTPI(-4.6%),62 patients were divided into mild wasting group(31 cases) and severe wasting group(31 cases). The incidence of ≥grade Ⅱ complications in severe wasting group was higher than that in mild wasting group(P<0.05). Univariate and multivariate logistic regression analysis showed that early postoperative severe skeletal muscle wasting, ASA-PS grade 3 and preoperative sarcopenia were the risk factors for postoperative grade≥Ⅱ complications(P<0.05).Conclusion In ESCC patients, severe wasting of skeletal muscle can occur in the early postoperative period after MIE, which is associated with postoperative ≥Ⅱ complications.

关 键 词：食管鳞状细胞癌 骨骼肌消耗 术后并发症 微创食管切除术 

分 类 号：R735[医药卫生—肿瘤]