肌肉减少症预测结直肠癌术后切口疝发生的应用研究  

Application of sarcopenia in predicting incisional hernia after colorectal cancer surgery

作　　者：陈樽 王平 金华 周美玲 李青青 黄永刚 Chen Zun;Wang Ping;Jin Hua;Zhou Meiling;Li Qingqing;Huang Yonggang(Department of Hernia and Abdominal Surgery,Affiliated Hangzhou First People's Hospital,School of Medicine,Westlake University,Hangzhou 310003,Zhejiang Province,China;Department of Hernia and Abdominal Surgery,the Fourth School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou First People's Hospital,Hangzhou 310053,Zhejiang Province,China)

机构地区：[1]西湖大学医学院附属杭州市第一人民医院疝与腹壁外科,310003 [2]浙江中医药大学第四临床医学院(杭州市第一人民医院)疝与腹壁外科,310053

出　　处：《中华疝和腹壁外科杂志(电子版)》2024年第6期639-644,共6页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：浙江省自然科学基金联合基金项目(LBY24H180008)。

摘　　要：目的探讨肌肉减少症对结直肠癌术后切口疝发生的影响及预测价值。方法纳入2017年1月1日至2019年12月31日,因结直肠恶性肿瘤于西湖大学医学院附属杭州市第一人民医院行结直肠癌根治术的患者150例,回顾分析其临床资料。根据术后是否发生切口疝分为切口疝组(IH)和非切口疝组(NIH),通过勾画患者术前CT影像第3腰椎(L3)水平不同组织的面积,获得术前的肌肉量。应用Cox回归分析肌肉减少症及其他临床因素对结直肠癌患者术后切口疝发生的影响,并根据多因素分析绘制列线图模型预测结直肠癌患者术后切口疝的发生风险。结果在随访期内共有26例(17.3%)结直肠癌患者术后出现了切口疝,IH组患者L3水平的骨骼肌指数为(44.7±7.6)cm^(2)/m^(2),明显低于NIH组(49.1±9.0)cm^(2)/m^(2),差异有统计学意义(t=-2.600,P=0.013)。在多因素分析中,肌肉减少症(HR=3.709,P=0.004)、直肠癌(HR=3.982,P=0.002)和开腹手术(HR=2.404,P=0.043)为结直肠癌术后出现切口疝的独立危险因素,并依此建立结直肠癌术后切口疝发生的预测模型。结论肌肉减少症、直肠癌、开腹手术是结直肠恶性肿瘤患者术后切口疝发生的独立危险因素,可用于评估术后切口疝的发生风险。Objective To investigate the impact and predictive value of sarcopenia on the occurrence of incisional hernia after colorectal cancer surgery.Methods A retrospective analysis was conducted on the clinical data of 150 patients who underwent radical surgery for colorectal cancer at Hangzhou First People's Hospital,Affiliated with the School of Medicine,Westlake University,from January 1,2017,to December 31,2019.Patients were divided into the incision hernia group(IH)and the non-incision hernia group(NIH)according to postoperative imaging findings.The preoperative muscle mass of patients was obtained by delineating the areas of different tissues at the level of the third lumbar vertebra(L3)in CT images.Cox regression was used to analyze the influence of sarcopenia and other clinical factors on postoperative incisional hernia in patients with colorectal cancer,and a nomogram model was established according to multivariate analysis to predict the risk of postoperative incisional hernia in patients with colorectal cancer.Results During the follow-up period,26 patients(17.3%)developed incisional hernia after operation,and the skeletal muscle index(SMI)of L3 level in the IH group was(44.7±7.6)cm^(2)/m^(2),which was significantly lower than that in NIH group(49.1±9.0)cm^(2)/m^(2),the difference was statistically significant(t=-2.600,P=0.013).In multivariate analysis,it was found that sarcopenia(HR=3.709,P=0.004),rectal cancer(HR=3.982,P=0.002)and laparotomy(HR=2.404,P=0.043)were independent risk factors for the prognosis of postoperative incisional hernia in colorectal cancer,and a prediction model of postoperative incisional hernia in colorectal cancer was established accordingly.Conclusion Sarcopenia,rectal cancer and laparotomy are independent risk factors for postoperative incisional hernia in patients with colorectal cancer,which can be used to evaluate the incidence of postoperative incisional hernia.

关 键 词：切口疝 结直肠癌 肌肉减少症 预后 

分 类 号：R73[医药卫生—肿瘤]