术前身体质量指数对肝门部胆管癌根治性切除术后感染影响的多中心研究  

Association between preoperative body mass index and postoperative infection in patients undergoing radical resection for perihilar cholangiocarcinoma:A multicentre study

作　　者：王婧婧 车晓宇 左菁华 庞书杰 陈龙飞 白洁 殷显玉 陈志宇 邱琰 WANG Jingjing;CHE Xiaoyu;ZUO Jinghua;PANG Shujie;CHEN Longfei;BAI Jie;YIN Xianyu;CHEN Zhiyu;QIU Yan(Department of Hepatobiliary Surgery,People’s Liberation Army Institute of Hepatobiliary Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Hepatobiliary Surgery,Eastern Hepatobiliary Surgery Hospital,Navy Medical University,Shanghai 200438,China;Department of General Surgery,the Third Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563099,China)

机构地区：[1]陆军军医大学第一附属医院肝胆外科/全军肝胆外科研究所,重庆400038 [2]海军军医大学附属东方肝胆外科医院肝胆外科,上海200438 [3]遵义医科大学第三附属医院普通外科,贵州遵义563099

出　　处：《肝胆胰外科杂志》2024年第7期400-406,411,共8页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探索肝门部胆管癌(pCCA)根治性切除术患者术前BMI与术后感染之间的关系。方法对2008年1月至2022年12月陆军军医大学第一附属医院、海军军医大学附属东方肝胆外科医院、遵义医科大学第三附属医院366例行根治性切除术的肝门部胆管癌(pCCA)患者的临床资料进行回顾性队列研究。根据术前身体质量指数(BMI)分组,BMI≤18.4 kg/m^(2)为低BMI组(n=31),18.4 kg/m^(2)<BMI<25.0 kg/m^(2)为正常BMI组(n=279),BMI≥25.0 kg/m^(2)为高BMI组(n=56)。研究结局为术后感染,包括切口部位感染、器官/腔隙感染和远程感染,比较3组术后感染的发生率。采用单因素和多因素Logistic回归模型确定与术后感染相关的独立危险因素。结果低BMI组和高BMI组患者的总体术后感染、切口部位感染发生率均显著高于正常BMI组(总体术后感染:45.2%、51.8%vs 26.5%,P=0.029、P<0.001;切口部位感染:32.3%、35.7%vs 16.8%,P=0.036、P=0.001)。多因素Logistic回归模型分析发现,低BMI和高BMI与总体术后感染(低BMI vs正常BMI:OR=2.380,95%CI 1.103-5.136;高BMI vs正常BMI:OR=3.224,95%CI 1.740-5.972)、切口部位感染(低BMI vs正常BMI:OR=2.601,95%CI 1.139-5.941;高BMI vs正常BMI:OR=2.451,95%CI 1.279-4.698)的发生均独立相关。结论BMI异常的pCCA患者根治性切除术后感染风险更大。应加强对BMI异常的pCCA患者围手术期管理,以降低根治性切除术后感染发生的风险。Objective To explore the relationship between preoperative BMI and postoperative infection in patients undergoing radical pCCA resection.Methods This study was a retrospective study.All data were collected from a multicentre database of the First Affiliated Hospital of Army Medical University,Eastern Hepatobiliary Surgery Hospital,and the Third Affiliated Hospital of Zunyi Medical University.Clinical data of patients undergoing radical pCCA resection were included in the database between Jan.2008 and Dec.2022.According to the value of preoperative body mass index(BMI),366 patients were divided into the low BMI group(BMI≤18.4 kg/m^(2)),the normal BMI group(18.4 kg/m^(2)<BMI<25.0 kg/m^(2))and the high BMI group(BMI≥25.0 kg/m^(2)).Postoperative infection was the outcome of the study,including incision site infection,organ/lacuna infection,and distant infection.The incidence of postoperative infection among the 3 groups was compared.Univariate and multivariate Logistic regression models were used to determine the independent risk factors associated with postoperative infection.Results The incidences of total postoperative infection and incision site infection in the low BMI group and the high BMI group were significantly higher than that in the normal BMI group(total postoperative infection:45.2%,51.8%vs 26.5%,P=0.029 and P<0.001;incision site infection:32.3%,35.7%vs 16.8%,P=0.036 and P=0.001).Multivariable Logistic regression model analysis found that low BMI and high BMI were independently correlated with total postoperative infection(low BMI vs normal BMI:OR=2.380,95%CI 1.103-5.136;high BMI vs normal BMI:OR=3.224,95%CI 1.740-5.972)and incision site infection(low BMI vs normal BMI:OR=2.601,95%CI 1.139-5.941;high BMI vs normal BMI:OR=2.451,95%CI 1.279-4.698).Conclusion pCCA patients with abnormal BMI have a higher risk of postoperative infection after radical resection surgery.For pCCA patients,it is necessary to strengthen perioperative management of abnormal BMI,to reduce the risk of postoperative infection.

关 键 词：术后感染 手术部位感染 身体质量指数 肝门部胆管癌 根治性切除术 

分 类 号：R735.8[医药卫生—肿瘤] R619.3[医药卫生—临床医学]