术前营养风险与食管癌术后颈部吻合口瘘的相关性研究

摘要

目的 应用营养风险筛查表-2002(NRS-2002)评估食管癌患者术前的营养风险,并分析其与食管癌术后颈部吻合口瘘的关系.方法 对确诊为食管癌并行颈胸腹三切口切除术的134例患者术前进行NRS-2002评分,总评分≥3分为营养风险组,总评分<3分为无营养风险组,并统计术后颈部吻合口瘘的发生率.结果 134例中营养风险组91例,无营养风险组43例.≥60岁营养风险检出率为75.6%,<60 岁营养风险检出率为54.2%,差异有统计学意义(P=0.011);I期、Ⅱ期和Ⅲ期营养风险检出率分别为33.3%、70.3%和76.3%,差异有统计学意义(P=0.001).营养风险组术后颈部吻合口瘘的发生比例明显高于无营养风险组(18.68% vs 4.65%),差异有统计学意义(P=0.030),多因素Logistic回归分析结果 提示术前存在营养风险是术后出现颈部吻合口瘘的独立危险因素(P=0.014).结论 食管癌患者存在较高营养风险,与年龄和病理分期相关.对于存在营养风险的食管癌患者,提示发生颈部吻合口瘘的概率增加,应积极进行围手术期间的营养支持治疗.%Objective To assess the preoperative nutritional risk of patients with esophageal carcinoma by using Nutritional Risk Screening-2002,and to analyze the relationship between nutritional risk and cervical anastomotic leakage after the operation of esophageal carcinoma.Methods The preoperative nutritional risks of 134 patients with 3-incision esophagectomy (cervical-thoraco-abdominal) in department of cardiothoracic surgery,were investigated by using NRS-2002.The total score of more than 3 was the nutritional risk group,the total score of less than 3 was the non-nutritional risk group,and the incidence rates of cervical anastomotic leakage after operation were statistically calculated.Results 134 patients,nutritional risk group included 91 cases,while non-nutritional risk group included 43 cases.The nutritional risk rate of patients ≥60 years old was 75.6%,and the nutritional risk rate of patients <60 years old was 54.2%;there were statistically significant differences (P=0.011).Phase I,Ⅱ and Ⅲ nutritional risk rates were 33.3%,70.3% and 76.3%,respectively;the differences were statistically significant(P=0.001).The incidence of postoperative cervical anastomotic leakage in nutritional risk group was significantly higher than in non-nutritional risk group (18.68% vs 4.65%);the difference was statistically significant(P=0.030).Multivariate Logistic regression analysis showed that preoperative nutritional risk was an independent risk factor for postoperative cervical anastomotic leakage (P=0.014).Conclusions Patients with esophageal cancer have higher nutritional risk,which have a certain relationship with age and pathological stage.For esophageal cancer patients with nutritional risk,the risk of cervical anastomotic leakage should be increased,and the nutritional support during perioperative period should be actively carried out.