术前CT人体成分分析对胃癌根治术的临床价值  

Clinical value of preoperative computed tomography analysis of body composition after radical gastrectomy

作　　者：刘长跃[1] 管锦坤 单龙成[1] Liu Changyue;Guan Jinkun;Shan Longcheng(Department of General Surgery,Jianhu People's Hospital,Jianhu Clinical Medical College of Yangzhou University,Jiangsu Yancheng 224799,China)

机构地区：[1]建湖县人民医院普通外科扬州大学建湖临床医学院,江苏盐城224799

出　　处：《腹部外科》2024年第1期69-75,共7页Journal of Abdominal Surgery

摘　　要：目的通过术前CT图像计算内脏脂肪面积、骨骼肌面积及密度,分析人体成分改变与胃癌根治术术后并发症的关系。方法回顾性分析自2020年1月至2023年1月在建湖县人民医院普通外科接受胃癌根治术病人的资料,观察指标包括基线指标、人体成分组成、手术资料及术后并发症发生情况。采用logistic回归分析的方法探索与胃癌术后并发症相关的因素。结果共纳入118例病人,其中男性76例,女性42例,平均年龄为66.5岁。术前内脏型肥胖、肌肉减少症、肌肉脂肪化的发生率分别为30.5%(36/118)、35.6%(42/118)、39.8%(47/118)。118例病人中,全胃切除术29例,胃大部切除术89例。术后胃排空障碍、切口感染、肺部并发症、腹腔感染、吻合口瘘、术后出血的发生率分别为13.6%(16/118)、11.0%(13/118)、10.2%(12/118)、9.3%(11/118)、6.8%(8/118)、3.4%(4/118),其中Clavien-DindoⅢ级以上并发症发生率为7.6%(9/118)。内脏型肥胖者与无内脏型肥胖者比较,手术时间延长[208(185,222)min比180(164,206)min,P=0.001],术中出血量增加[230(220,250)mL比180(165,190)mL,P=0.001]。伴有肌肉减少症者与无肌肉减少症者比较,术后更易出现吻合口瘘(16.7%比1.3%,P=0.001)及腹腔感染(19.0%比3.9%,P=0.007)。而诊断有肌肉脂肪化病人的以下指标高于无肌肉脂肪化病人:术后胃排空障碍发生率(23.4%比7.0%,P=0.011),肺部并发症发生率(19.1%比4.2%,P=0.009),总体并发症发生率(55.3%比22.5%,P=0.001)。多因素logistic回归分析显示,术前诊断为肌肉脂肪化是胃癌根治术后出现并发症的独立危险因素[OR=4.256,95%CI(1.192,9.475),P=0.001]。结论术前CT可较为准确地反映病人人体成分组成状况,以评估其营养状况,而术前人体成分的变化与胃癌术后并发症的发生有一定关联。Objective To assess the relationship between body composition alteration and complications after radical gastrectomy through analyzing morphometric parameters from preoperative computed tomography(CT)images.Methods The relevant clinical data were retrospectively reviewed for 118 patients undergoing radical gastrectomy from January 2020 to January 2023.Baseline profiles,body composition parameters,surgical findings and postoperative morbidities were recorded.Logistic regression analysis was performed for examining the factors associated with occurrence of postoperative complications.Results There were 76 males and 42 females with an average age of 66.5 year.Visceral obesity,sarcopenia and myosteatosis occurred in 30.5%(36/118),35.6%(42/118)and 39.8%(47/118).There were total gastrectomy(n=29)and subtotal gastrectomy(n=89).Incidence of delayed gastric emptying,wound infection,pulmonary disease,surgical site infection,anastomotic leakage and postoperative hemorrhage were 13.6%(16/118),11.0%(13/118),10.2%(12/118),9.3%(11/118),6.8%(8/118)and 3.4%(4/118)respectively.Complications above Clavien-DindoⅢaccounted for 7.6%(9/118).Visceral obesity was correlated closely with prolonged operative duration and greater intraoperative hemorrhage.Individuals with sarcopenia were more prone to anastomotic leakage and abdominal infection.In patients of myosteatosis,the incidence of postoperative gastric emptying disorders and pulmonary complications(as well as overall complications)was higher in those without myosteatosis.Multivariate logistic regression analysis indicated that myosteatosis was independent risk factor for postoperative complications after radical gastrectomy[OR=4.256,95%CI(1.192,9.475),P=0.001].Conclusion Preoperative CT images may accurately reflect the body composition of patients for further evaluations of nutrition status.And occurrence of complications are correlated closely with the alteration of body composition after radical gastrectomy.

关 键 词：CT图像 内脏型肥胖 肌肉减少症 肌肉脂肪化 胃癌 并发症 

分 类 号：R857.6[医药卫生—航空、航天与航海医学]