营养状态对老年右半结肠癌患者术后并发症的影响  

The impact of nutritional status on postoperative complications in elderly patients with right-sided colon cancer

作　　者：呼冉 薛丹 李宏洁 姚宏伟[1] 孙萌[2] Hu Ran;Xue Dan;Li Hongjie;Yao Hongwei;Sun Meng(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Nursing,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科中心,北京100050 [2]首都医科大学附属北京友谊医院护理部,北京100050

出　　处：《国际外科学杂志》2023年第12期812-817,F0003,共7页International Journal of Surgery

基　　金：首都卫生发展科研专项(2018-1-1111)。

摘　　要：目的探究老年右半结肠癌患者术前营养状况与术后并发症之间的相关性。方法前瞻性收集2021年9月—2022年6月全国52家三甲医院右半结肠癌手术前瞻性登记数据库中共计1196例接受右半结肠癌根治术患者的临床资料。其中男性627例,女性569例,年龄为64(53,71)岁,发生并发症患者共136例,未发生并发症共1060例。入组患者按照年龄分为老年组(≥65岁,n=571)和中青年组(<65岁,n=625)。收集两组患者的术前营养学评估指标、临床病理特征以及术后30 d内并发症的发生情况。正态分布的计量资料采用均数±标准差(±s)表示,组间比较采用t检验;非正态分布的计量资料采用M(Q_1,Q_3)表示,组间比较采用Wilcoxon秩和检验分析;计数资料组间比较采用χ~2检验或Fisher确切概率法。在老年患者术后并发症危险因素分析方面,先对所有可能的危险因素进行单因素分析,再将单因素回归分析中有统计学意义的变量纳入多因素logistic回归模型。结果术后并发症的总发生率为11.37%(136/1196),常见并发症包括切口感染(2.26%)、肠梗阻(2.26%)、吻合口漏(1.42%)、深静脉血栓(1.42%)和乳糜漏(1.42%)等。老年组患者中,术前存在营养风险的患者发生并发症的比例显著高于未发生并发症的患者(66.20%比53.40%,P=0.043)。在多因素分析中,体重指数(OR=1.058,95%CI:1.005~1.117,P=0.031)和营养风险(OR=1.803,95%CI:1.066~3.126,P=0.031)被确认为老年患者术后并发症的独立危险因素。结论老年右半结肠癌患者的术前营养状态与术后并发症的发生存在相关性,尤其是体重指数和营养风险。这些结果强调了在老年患者中进行术前营养评估和干预的重要性,以减少术后并发症发生的风险。Objective:To explore the correlation between preoperative nutritional status and postoperative complications in elderly patients with right-sided colon cancer.Methods:A prospective registry database of 1,196 patients undergoing curative surgery for right-sided colon cancer was collected from 52 top-tier hospitals nationwide between September 2021 and June 2022.The cohort included 627 males and 569 females,with an age range of 64(53,71)years.Among these,136 patients developed complications,while 1,060 did not.Patients were divided into two groups based on age:the elderly group(≥65 years,n=571)and the middle-aged group(<65 years,n=625).Preoperative nutritional assessment indicators,clinical pathological data,and the incidence of complications within 30 days post-surgery were collected.For normally distributed quantitative data,mean±standard deviation(±s)was used,and the t-test was applied for intergroup comparisons.Non-normally distributed quantitative data were represented as M(Q1,Q3)and analyzed using the Wilcoxon rank-sum test;categorical data were compared using the chi-square test or Fisher′s exact test.In the analysis of risk factors for postoperative complications in elderly patients,univariate analysis was first conducted on all potential risk factors,followed by the inclusion of statistically significant variables from univariate regression into a multivariate logistic regression model.Results:The overall incidence of postoperative complications was 11.37%(136/1196),with common complications includin wound infection(2.26%),intestinal obstruction(2.26%),anastomotic leakage(1.42%),deep vein thrombosis(1.42%),and chylous leakage(1.42%).In the elderly group,the proportion of patients with preoperative nutritional risk who developed complications was significantly higher than those without complications(66.20%vs.53.40%,P=0.043).In the multivariate analysis,body mass index(OR=1.058,95%CI:1.005-1.117,P=0.031)and nutritional risk(OR=1.803,95%CI:1.066-3.126,P=0.031)were identified as independent risk factors

关 键 词：结肠肿瘤 手术后并发症 营养评价 老年人 

分 类 号：R735.35[医药卫生—肿瘤]