术前肌肉减少症与老年食管鳞癌病人术后吻合口瘘的相关性  

Relationship between preoperative sarcopenia and postoperative anastomotic leakage in elderly patients with esophageal squamous cell carcinoma

作　　者：陆鹏 张明志 徐克平[2] 张少红 汪为民[1] 田文泽[2] LU Peng;ZHANG Mingzhi;XU Keping;ZHANG Shaohong;WANG Weimin;TIAN Wenze(Department of Geriatric Medicine,the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University,Huai’an 223300,China;Department of Thoracic Surgery,the Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University,Huai’an 223300,China)

机构地区：[1]南京医科大学附属淮安第一医院老年医学科,江苏省淮安市223300 [2]南京医科大学附属淮安第一医院胸外科,江苏省淮安市223300

出　　处：《实用老年医学》2024年第12期1255-1259,共5页Practical Geriatrics

基　　金：淮安市自然科学研究计划(HAB202201);江苏省卫生健康委员会医学科研面上项目(H2023083);江苏省医学重点学科建设单位(JWDS202233)。

摘　　要：目的探讨肌肉减少症与接受微创食管癌根治术的老年食管鳞癌病人术后吻合口瘘的相关性。方法回顾性分析2020-2022年南京医科大学附属淮安第一医院接受微创胸腹腔镜联合下食管癌根治术的953例老年食管鳞癌病人的临床资料,统计病人术前肌肉减少症的发生情况和相关临床、病理指标,分析上述指标与术后吻合口瘘发生的相关性。结果行微创食管癌根治术的食管鳞癌病人术后吻合口瘘的发生率为4.83%(46/953);吻合口瘘组病人术前合并肌肉减少症、术后肺炎、手术时间<4 h比例均明显高于非吻合口瘘组(χ^(2)值分别为10.563、30.413、8.779,P<0.01);多因素Logistic回归分析显示,术前合并肌肉减少症、术后肺炎、手术时间<4 h是食管鳞癌病人微创食管癌根治术后发生吻合口瘘的危险因素。结论术前合并肌肉减少症是接受微创食管癌根治术的老年食管鳞癌病人术后吻合口瘘发生的高危因素,可以作为术前早期评估的关键指标。Objective To explore the relationship between preoperative sarcopenia and postoperative anastomotic leakage in the elderly patients with esophageal squamous cell carcinoma undergoing minimally invasive radical surgery for esophageal cancer.Methods A retrospective analysis was conducted on the clinical data of 953 elderly patients with esophageal squamous cell carcinoma who underwent minimally invasive thoracolaparoscopy combined with radical esophagectomy in the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University from January 2020 to December 2022.The incidence of sarcopenia and related clinical and pathological indicators of the patients were recorded,and the correlation between the above indicators and the incidence of postoperative anastomotic leakage was analyzed.Results The incidence rate of postoperative anastomotic leakage in the elderly patients with esophageal squamous cell carcinoma undergoing minimally invasive radical esophagectomy was 4.83%(46/953).Compared with the non-anastomotic leakage group,the anastomotic leakage group had higher proportion of preoperative sarcopenia,postoperative pneumonia and surgery time<4 hours(P<0.01).Multivariate Logistic analysis showed that preoperative sarcopenia,postoperative pneumonia and surgery time<4 hours were risk factors for postoperative anastomotic leakage in the patients with esophageal squamous cell carcinoma undergoing minimally invasive esophageal cancer radical surgery.Conclusions Preoperative sarcopenia is a high-risk factor for postoperative anastomotic leakage in the elderly patients with esophageal squamous cell carcinoma undergoing minimally invasive radical esophagectomy,and can be used as a key indicator for early preoperative evaluation.

关 键 词：食管癌 肌肉减少症 吻合口瘘 腰大肌指数 老年人 

分 类 号：R735.1[医药卫生—肿瘤]