肌少症对溃疡性结肠炎行结直肠切除术后手术部位感染的影响。
Impact of sarcopenia on surgical site infection after restorative proctocolectomy for ulcerative colitis.
作者信息
Fujikawa Hiroyuki, Araki Toshimitsu, Okita Yoshiki, Kondo Satoru, Kawamura Mikio, Hiro Junichiro, Toiyama Yuji, Kobayashi Minako, Tanaka Koji, Inoue Yasuhiro, Mohri Yasuhiko, Uchida Keiichi, Kusunoki Masato
机构信息
Division of Reparative Medicine, Department of Gastrointestinal and Pediatric Surgery, Institute of Life Sciences, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
出版信息
Surg Today. 2017 Jan;47(1):92-98. doi: 10.1007/s00595-016-1357-x. Epub 2016 Jun 2.
PURPOSE
The coexistence of sarcopenia is associated with postoperative complications, including infection after abdominal surgery. We evaluated the association between sarcopenia and surgical site infection (SSI) after surgery for ulcerative colitis.
METHODS
The subjects of this retrospective study were 69 patients who underwent restorative proctocolectomy with perioperative abdominal computed tomography (CT). Sarcopenia was diagnosed by measuring the cross-sectional area of the right and left psoas muscles as the total psoas muscle area on CT images. We assessed whether sarcopenia was associated with SSI and clinical factors, including nutritional and inflammatory markers.
RESULTS
The lowest quartiles defined as sarcopenia in men and women were 567.4 and 355.8 mm/m, respectively. According to this classification, 12 men and 6 women had sarcopenia. Patients with sarcopenia had a lower body mass index (p = 0.0004) and a higher C-reactive protein concentration (p = 0.05) than those without sarcopenia. SSIs were identified in 12 patients (17.3 %) and included six pelvic abscesses and seven wound infections. According to multivariate analysis, sarcopenia was an independent risk factor for SSI (odds ratio = 4.91, 95 % confidence interval 1.09-23.5, p = 0.03).
CONCLUSION
Sarcopenia is predictive of SSI after pouch surgery for ulcerative colitis.
目的
肌肉减少症的共存与术后并发症相关，包括腹部手术后的感染。我们评估了溃疡性结肠炎手术后肌肉减少症与手术部位感染（SSI）之间的关联。
方法
这项回顾性研究的对象是69例行保留直肠结肠切除术并术前行腹部计算机断层扫描（CT）的患者。通过测量CT图像上左右腰大肌的横截面积作为总腰大肌面积来诊断肌肉减少症。我们评估了肌肉减少症是否与SSI及包括营养和炎症标志物在内的临床因素相关。
结果
男性和女性中定义为肌肉减少症的最低四分位数分别为567.4和355.8 mm/m。根据此分类，12名男性和6名女性患有肌肉减少症。与无肌肉减少症的患者相比，肌肉减少症患者的体重指数较低（p = 0.0004），C反应蛋白浓度较高（p = 0.05）。12例患者（17.3%）发生了SSI，包括6例盆腔脓肿和7例伤口感染。根据多变量分析，肌肉减少症是SSI的独立危险因素（比值比=4.91，95%置信区间1.09 - 23.5，p = 0.03）。
结论
肌肉减少症可预测溃疡性结肠炎贮袋手术后的SSI。
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