肌少症在慢性放射性肠炎合并肠梗阻病人中的发生率及围手术期影响
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摘要
目的:研究肌少症在慢性放射性肠炎(CRE)合并肠梗阻病人中发生率及对手术治疗的近期影响。方法:回顾性分析84例CRE合并肠梗阻并接受病变部位外科手术病人的临床资料。结果:84例病人中,肌少症35例(41.67%)。肌少症组病人放疗时程、营养风险筛查2002(NRS 2002)评分和超敏C反应蛋白(hs-CRP)与非肌少症组比较有显著性差异(P <0.05)。肌少症组病人感染性并发症发生率较非肌少症组显著增加,术后住院时间显著延长(P <0.05)。肌少症与放疗时程、NRS 2002评分差异、hs-CRP呈负相关(r=-0.786、-0.698、-0.639,P <0.05)。结论:肌少症在CRE合并肠梗阻病人中发生率较高,可增加感染性并发症发生率、延长住院时间,与病人放疗时程、营养风险及炎症状态有一定相关性。
Objective: To study the incidence and surgical outcomes associated with sarcopenia in chronic radiation enteritis(CRE) patients complicated with intestinal obstruction. Methods: The clinical data of 84 patients with CRE combined with intestinal obstruction who underwent surgical resection were retrospectively analyzed.Results: The incidence of sarcopenia was 41.67%(35 of 84). Significant differences were observed in the radiotherapy duration, nutritional risk screening 2002(NRS 2002) score and the hypersensitive C-reactive protein(hs-CRP) between the two groups(P < 0.05). Infectious complications and postoperative hospitalization time in sarcopenia group were significantly deteriorated than non-sarcopenia group. Sarcopenia was negatively correlated with radiotherapy duration,NRS 2002 score, and hs-CRP(r =-0.786,-0.698,-0.639, P < 0.05). Conclusion: Sarcopenia has a high incidence in CRE patients combined with intestinal obstruction. Sarcopenis can increase the incidence of infectious complications and prolong the time of hospitalization. Sarcopenis is correlated with radiotherapy duration, nutritional risk and inflammatory status.
Objective: To study the incidence and surgical outcomes associated with sarcopenia in chronic radiation enteritis(CRE) patients complicated with intestinal obstruction. Methods: The clinical data of 84 patients with CRE combined with intestinal obstruction who underwent surgical resection were retrospectively analyzed.Results: The incidence of sarcopenia was 41.67%(35 of 84). Significant differences were observed in the radiotherapy duration, nutritional risk screening 2002(NRS 2002) score and the hypersensitive C-reactive protein(hs-CRP) between the two groups(P < 0.05). Infectious complications and postoperative hospitalization time in sarcopenia group were significantly deteriorated than non-sarcopenia group. Sarcopenia was negatively correlated with radiotherapy duration,NRS 2002 score, and hs-CRP(r =-0.786,-0.698,-0.639, P < 0.05). Conclusion: Sarcopenia has a high incidence in CRE patients combined with intestinal obstruction. Sarcopenis can increase the incidence of infectious complications and prolong the time of hospitalization. Sarcopenis is correlated with radiotherapy duration, nutritional risk and inflammatory status.
引文
[1]龚剑峰,朱维铭,虞文魁,等.慢性放射性肠炎合并梗阻病变肠管切除术后早期并发症危险因素分析.中国实用外科杂志,2013,33(7):571-575.
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[11] Friedman AN, Fadem SZ. Reassessment of Albumin as a Nutritional Marker in Kidney Disease. J Am Soc Nephrol, 2010,21(2):223-230.
[12]田浩,周达,叶晨,等.术前肌肉减少症对胃癌病人临床预后的影响:一项前瞻性队列研究.肠外与肠内营养,2018,(3):166-170,175.
[13] Cai Z, Cai D, Yao D, et al. Associations between body composi‐tion and nutritional assessments and biochemical markers in pa‐tients with chronic radiation enteritis:a case–control study. Nutr J, 2015, 15(1):1-8.
[2]王剑锋,方芳,于雷.营养干预对头颈部肿瘤急性放射性口腔粘膜反应的影响.肠外与肠内营养,2018,(1):28-31.
[3] Dindo D, Demartines N, Clavien PA. Classification of surgical complications:a new proposal with evaluation in a cohort of6336 patients and results of a survey. Ann Surg, 2004, 240(2):205-213.
[4] Rosenberg IH. Summary comments. Am J Clin Nutr, 1989, 50(l):1231S-1233S.
[5] Von HS, Morley JE, Anker SD. From muscle wasting to sarcopenia and myopenia:update 2012. J Cachexia Sarcopenia Muscle, 2012, 3(4):213-217.
[6]任建安.临床营养治疗的挑战与机遇.肠外与肠内营养,2016,(1):1-3.
[7] Del Signore S, Roubenoff R. Physical frailty and sarcopenia(PF&S):a point of view from the industry. Aging Clin Exp Res,2017, 29(1):69-74.
[8] Zhu W, Gong J, Li Y, et al. A retrospective study of surgical treatment of chronic radiation enteritis. J Surg Oncol, 2012, 105(7):632-636.
[9] Cosnes J, Gendre JP, Le Quintrec Y. Chronic radiation enteritis.II. General consequences and prognostic factors. Gastroentérol Clin Biol, 1983, 7(8-9):671-676.
[10] Hennessey DB, Burke JP, Nidhonochu T, et al. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery:a multi-institutional study. Ann Surg, 2010, 252(2):325-329.
[11] Friedman AN, Fadem SZ. Reassessment of Albumin as a Nutritional Marker in Kidney Disease. J Am Soc Nephrol, 2010,21(2):223-230.
[12]田浩,周达,叶晨,等.术前肌肉减少症对胃癌病人临床预后的影响:一项前瞻性队列研究.肠外与肠内营养,2018,(3):166-170,175.
[13] Cai Z, Cai D, Yao D, et al. Associations between body composi‐tion and nutritional assessments and biochemical markers in pa‐tients with chronic radiation enteritis:a case–control study. Nutr J, 2015, 15(1):1-8.