【摘要】 目的探讨术前骨骼肌含量减低对老年胃癌患者腹腔镜胃切除术后并发症及预后的影响。方法回顾性纳入因胃癌行腹腔镜胃切除术的老年患者183例,术后随访3年。利用医院病例系统查找患者术前腹部CT L3水平图像,测量L3平面腰大肌总面积。依据腰大肌指数评估患者低骨骼肌含量(LSMM)的发生情况。比较有、无LSMM的老年胃癌患者的临床特征、术后并发症情况、3年总生存率。结果术前有LSMM的老年胃癌患者为134例(73.22%)。与无LSMM的患者相比,有LSMM的老年胃癌患者年龄较大、BMI较低、NRS2002≥3分比例较高、白蛋白水平较低、住院天数较长(P均<0.05)。183例老年胃癌患者出现术后并发症者32例(17.49%)。与无LSMM的患者相比,有LSMM的老年胃癌患者术后并发症发生率较高(OR=2.972,95%CI为0.985～8.965,P=0.045)。NRS2002≥3分、白蛋白水平较低、总蛋白水平较低、血红蛋白水平较低、淋巴细胞计数较低的老年胃癌患者术后并发症发生率较高(P均<0.05)。NRS2002≥3分是老年胃癌患者发生术后并发症的独立危险因素(OR=13.632,95%CI为3.042～61.094,P=0.001)。有LSMM的老年胃癌患者3年总生存率低于无LSMM患者(55.97%VS 69.39%,P=0.047)。结论老年胃癌患者术前存在LSMM的概率较高。有LSMM的老年胃癌患者术后并发症发生率较高,且3年总生存率较低。更多还原

【Abstract】 Objective To determine the impact of preoperative low skeletal muscle mass(LSMM)on postoperative complications and prognosis in elderly patients who undergo laparoscopic gastrectomy for gastric cancer(GC).Methods Elderly patients who undergo laparoscopic gastrectomy for GC were enrolled,and they were followed up for three years. Third lumbar vertebra bilateral psoas muscles mass was assessed by computer tomography(CT). According to the psoas muscle index(PMI),the incidence of LSMM in elderly patients with GC was evaluated. The clinical data,postoperative complications and 3-year overall survival(OS)rate of elderly patients with and without LSMM were compared.Results A total of 134 cases(73. 22%)were diagnosed as LSMM. Compared with patients without LSMM,patients with LSMM had older,lower BMI,more NRS2002 ≥ 3,lower albumin and longer hospital stay(all P < 0. 05). Among 183 elderly patients with GC,32(17. 49%)had postoperative complications. Compared with patients without LSMM,patients with LSMM had a higher incidence of postoperative complications(OR=2. 972, 95%CI:0. 985-8. 965, P=0. 045). Patients with NRS2002 ≥ 3,lower albumin,lower total protein,lower hemoglobin and lower lymphocyte count had higher incidence of postoperative complications(all P < 0. 05). NRS2002 ≥ 3(OR=13. 632,95%CI:3. 042-61. 094,P=0. 001)was an independent risk factor for postoperative complications. The 3-year OS rate in patients with LSMM was significantly lower than that in patients without LSMM(55. 97% VS 69. 39%,P=0. 047).Conclusions LSMM is common in elderly patients with GC before surgery. The incidence of postoperative complications was higher in elderly patients with LSMM,and the 3-year OS rate was lower.更多还原