中国实用外科杂志

中国实用外科杂志

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3种营养筛查工具对腹腔镜结直肠癌切除术后并发症预测价值研究

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  1. 1安徽医科大学上海临床学院，上海200072； 2同济大学附属第十人民医院，上海200072；3上海交通大学第六人民医院，上海200072
  • 出版日期:2018-03-01 发布日期:2018-03-06

  • Online:2018-03-01 Published:2018-03-06

摘要：

目的    探讨适用于预测腹腔镜结直肠癌切除术后并发症的最适营养筛查工具。方法    选择2016年3月至2017年6月同济大学附属第十人医院收治的197例择期行腹腔镜结直肠癌切除术的病人临床资料。单因素及多因素Logistic回归分析探讨术后并发症的相关因素，并分析比较3种营养筛查（NRS2002、MUST、NRI）与术后并发症的关系，采用多因素分析P＜0.05的因素，构建腹腔镜结直肠癌切除术后并发症模型。结果    197例结直肠癌病人中，其中60例（30.5%）病人发生并发症。使用NRS2002、MUST、NRI评估营养风险发生率分别为32.0%、42.6%、24.4%。发生并发症组病人的住院时间（P＜0.001）及住院费用（P＜0.001）明显高于未发生并发症组。单因素分析显示，年龄≥70岁（OR=2.455，P=0.005）和NRI评分＜97.5分（OR=2.194，P=0.021）是并发症发生的危险因素。多因素分析显示，年龄≥70岁（OR=2.382，95%CI 1.228~4.620，P=0.010）、NRI评分＜97.5分（OR=2.067，95%CI 1.012~4.221，P=0.048）、手术时间≥180 min（OR=2.383，95%CI 1.149~4.939，P=0.020）是并发症发生的独立危险因素。腹腔镜结直肠癌切除术后并发症模型中，风险分数（0~3）对应的并发症发生率依次为16.5%、34.9%、48.4%、75.0%。结论 相较NRS2002和MUST，建议结直肠癌病人入院时使用NRI进行营养风险筛查，及早干预治疗。

关键词: 营养筛查工具, 结直肠癌, 腹腔镜, 并发症

Abstract:

Comparison of the three nutritional screening tools to predict complications after laparoscopic resection of colorectal cancer        JI Yan-bin*, SHEN Tong-yi, MA Bing-wei, et al. *Department of Gastrointestinal Surgery, Shanghai Clinical Institution, Anhui Medical University, Shanghai 200072, China
Corresponding author: YU Zhen,E-mail：yuzhen0577@163.com
Abstract    Objective    To identify the most appropriated nutritional screening tool for predicting postoperative complications after laparoscopic resection of colorectal cancer. Methods    The clinical data of 197 patients who underwent laparoscopic resection of colorectal cancer between March 2016 and June 2017 admitted in Shanghai Tenth People’s Hospital Affiliated to Tongji University were included prospectively. NRS2002， MUST and NRI were used to assess nutrition risk within 24h. Univariate and multivariate analysis were performed to evaluate the risk factors for postoperative complications and to compare the three nutritional screening tools to predict the occurrence of postoperative complications. The remained variables in the final logistic regression analysis were used to build a postoperative complication risk scoring model. Results    Among 197 patients， 60 patients of them （30.5%） developed complications. The nutrition risk was 32.0%， 42.6% and 24.4% according to the NRS2002， MUST and NRI， respectively. Patients with postoperative complications had a significantly longer postoperative hospital stay and higher cost than those without postoperative complications. In the univariate analysis， age ≥ 70 years （OR=2.455，P=0.005） and NRI ＜97.5（OR=2.194，P=0.021）were associated with postoperative complications. Multivariable analysis showed that age ≥ 70 years（OR=2.382，95%CI：1.228-4.620， P=0.010），NRI ＜97.5（OR=2.067，95%CI：1.012-4.221， P=0.048）， the duration of operation ≥ 180min（OR=2.383，95%CI： 1.149-4.939， P=0.020）were independent risk factors for postoperative complications. The probability of complications in scores (0-3) in the postoperative complication risk scoring model after laparoscopic colorectal cancer resection was 16.5%,34.9%,48.4%,75%,respectively. Conclusion    Compared with NRS2002 and MUST, NRI is recommended to perform for nutritional risk screening and early intervention when patients with colorectal cancer are admitted.

Key words: nutritional screening tool, colorectal cancer, laparoscopy, complication