结直肠癌患者肌少症的发生率及其对术后感染和住院时间的影响

目的:评价结直肠癌患者肌少症的发生率及其对术后感染和住院时间的影响。方法:回顾性分析了2013年4月至2019年10月在我院接受原发性结肠直肠癌根治术患者的临床数据。从病例资料中采集患者人口学和疾病资料,利用术前2周内拍摄的CT图像分析第3腰椎骨骼肌指数(L_(3)skeletal muscle index,L_(3)SMI)。以男性L_(3)SMI<52.4 cm^(2)/m^(2),女性<38.5 cm^(2)/m^(2),作为肌肉减少症的诊断标准。结果:共纳入234例符合入排标准的患者,其中91例(38.9%)患有肌少症。≥65岁的患者肌少症发病率高于<65岁的患者(48.6%vs 30.1%,P=0.004)。39例(16.7%)患者有术后感染记录。肌少症患者的感染记录高于非肌少症患者(23.1%vs 12.6%,P=0.036),在≥65岁的患者中尤其显著。肌少症患者的住院时间长于非肌少症患者,差异有统计学意义(P<0.05)。在多因素Logistic回归分析中,肌少症[OR(95%CI):4.6(1.5~13.9),P=0.007]和年龄≥65岁[OR(95%CI):4.7(1.5~8.6),P<0.001]是术后感染的独立预测因子。结论:肌少症预示着结肠直肠癌患者术后感染风险增加和住院时间延长,老年患者表现尤为突出。建议术前利用常规CT检查对患者肌肉减少情况进行评估,并以此作为评估患者术后感染的重要指标。

Characteristics of sarcopenia in patients with colorectal cancer and its influence on postoperative infection and hospital stay

Objective:To evaluate the characteristics of sarcopenia in colorectal cancer patients and its effect on postoperative infection and hospital stay.Methods:The clinical data of patients who underwent radical resection of primary colorectal cancer in our hospital from April 2013 to October 2019 were retrospectively analyzed.Demographic and disease data of patients were collected from case data,and the L3 skeletal muscle index(L3 SMI)of the 3rd lumbar spine was analyzed using CT images taken within 2 weeks before surgery.Male L3 SMI≤52.4 cm2/m2,female≤38.5 cm2/m2,as the diagnostic criteria for sarcopenia.Results:A total of 234 patients meeting the admission criteria were included,of which 91(38.9%)had sarcopenia.The incidence of sarcopenia was higher in patients ≥65 years of age than in patients < 65 years of age(48.6% vs 30.1%,P=0.004).Postoperative infection was recorded in 39 patients(16.7%).Records of infection were higher in patients with sarcopenia than in patients without sarcopenia(23.1% vs 12.6%,P=0.036),and were particularly significant in patients aged ≥65 years.The length of hospital stay of sarcopenia patients was longer than that of non-sarcopenia patients,and the difference was statistically significant(P＜ 0.05).In the multivariate Logistic regression analysis,sarcopenia［OR(95%CI):4.6(1.5~13.9),P=0.007］ and age ≥65 years ［OR(95%CI):4.7(1.5~8.6),P＜ 0.001］ were independent predictors of postoperative infection.Conclusion:Sarcopenia predicted an increased risk of postoperative infection and prolonged hospital stay in patients with colorectal cancer,especially in elderly patients.It is recommended to evaluate the muscle loss of patients with routine CT examination before surgery,anduse it as an important indicator to evaluate the postoperative infection of patients.