肠瘘合并肌少症病人内脏脂肪面积和腹肌面积指数比对术后肠功能恢复的影响  

Visceral fat-to-muscle ratio is associated with inflammatory ileus after small intestinal fistula resection in sarcopenic patients with severe abdominal adhesions

作　　者：李静 陈敏 马云丽 LI Jing;CHEN Min;MA Yun-li(Department of general surgery,Jinling Hospital,Nanjing 210002,Jiangsu,China)

机构地区：[1]东部战区总医院普通外科,江苏南京210002

出　　处：《肠外与肠内营养》2025年第1期35-41,共7页Parenteral & Enteral Nutrition

基　　金：国家自然科学基金面上项目(82170581);院管课题(2023JSYXMS152)。

摘　　要：目的:本研究旨在评估在合并严重腹腔粘连的肌少症病人中,内脏脂肪面积与总腹肌面积指数比(VFA/TAMAI)对小肠瘘切除术后炎性肠梗阻(PII)的可预测性。方法:回顾性纳入2016年1月至2022年1月期间东部战区总医院普通外科接受小肠瘘切除的肌少症病人,收集病人术前术中资料,采用单因素筛选后再使用多因素回归分析将VFA/TAMAI作为潜在PII的危险因素进行评估。结果:在本研究中,共纳入132名符合条件的病人,其中男性79(59.8%)名,中位年龄为52(39~61)岁。24(18.2%)例发生PII,术后4(2,5)d病人出现临时排便。在2(1,2)d的临时排便后再梗阻的持续时间为21(19,27)d。多因素Cox回归分析提示,VFA/TAMAI(HR=0.81,95%CI:0.65~0.99,P=0.04)对肠功能恢复有负面影响。多因素Logistic回归显示VFA/TAMAI与PII相关(OR=3.89,95%CI:1.88~7.92,P<0.001)。结论:内脏脂肪面积和总腹肌面积指数比与严重腹腔粘连病人小肠瘘切除术后炎性肠梗阻的发生相关。Objective:Postoperative inflammatory ileus(PII)is characterized by prolonged re-obstruction following temporary defecation after surgery.Small intestinal fistula resection(SIFE)in patients with severe abdominal adhesions may increase the risk of PII,particularly in those with oligomyosis.The ratio of visceral fat area(VFA)to total abdominal muscle area index(TAMAI)is thought to be associated with chronic inflammation and may negatively impact the recovery of intestinal motility after abdominal surgery.This study aims to evaluate the predictive value of VFA/TAMAI for postoperative PII in patients undergoing SIFE.Methods:Sarcopenic patients who underwent SIFE at Jinling Hospital between January 2016 and October 2022 were enrolled.Preoperative and intraoperative characteristics were analyzed.VFA/TAMAI was assessed as a potential risk factor for PII using regression analysis.Results:A total of 132 eligible patients(79 males[59.8%])with a median age of 52 years(interquartile range[IQR]:39~61 years)were included.Of these,18.2%(n=24)developed PII.Temporary defecation occurred 4 days after SIFE(IQR:2~5 days)and lasted for 2 days(IQR:1~2 days).Re-obstruction persisted for a median duration of 21 days(IQR:19~27 days)after temporary defecation.VFA/TAMAI was significantly associated with PII(OR=3.89,95%CI:1.88~7.92,P<0.001)and recovery of digestive tract function(HR=0.81,95%CI:0.65~0.99,P=0.04).Conclusion:VFA/TAMAI is associated with postoperative PII in sarcopenic patients with severe abdominal adhesions following SIFE.

关 键 词：术后梗阻 机体组成 肌少症 腹部手术 

分 类 号：R656[医药卫生—外科学]