Queen Alexandra Hospital - Portsmouth Hospitals NHS Trust, Portsmouth, UK.
University of Portsmouth, Portsmouth, UK.
Updates Surg. 2021 Aug;73(4):1419-1427. doi: 10.1007/s13304-020-00790-x. Epub 2020 May 14.
Measurement of the psoas muscle area has been applied to estimate lean muscle mass as a surrogate marker of sarcopenia, but there is a paucity of evidence regarding the influence of sarcopenia on clinical outcomes following inflammatory bowel disease surgery. The aim of this study was to evaluate the association between MRI enterography defined sarcopenia and postoperative complications in patients undergoing elective ileocaecal resection for Crohn's disease. To obtain cross sectional area measurement of the psoas muscle, the freehand area tool was used to trace the margin of each psoas muscle at the level of L4, with the sum recorded as Total Psoas Area (TPA). The total cross sectional muscle area of the abdominal wall was recorded as Skeletal Muscle Area (SMA), while myosteatosis was measured by normalising the psoas muscle intensity with the mean intensity of the cerebrospinal fluid. The primary outcome was the incidence of 30-day postoperative complications in patients in the lowest quartile of TPA and SMA. 31 patients were included and ten patients (32.25%) developed postoperative complications within 30 days of surgery. The cut-off values for the lowest quartile for TPA were 11.93 cm in men and 9.77 cm in women, including a total of 8 patients (25.8%) with 5 patients in this group (62.5%) developing postoperative complications and 3 patients (37.5%) Clavien-Dindo class ≥ 3 complications. The cut-off values for the lowest quartile for SMA were 73.49 cm in men and 65.85 cm in women, with 4 patients out of 8 (50%) developing postoperative complications. Psoas muscle cross sectional area and skeletal mass area can be estimated on Magnetic Resonance Enterography as surrogate markers of sarcopenia with high inter-observer agreement.
测量腰大肌面积已被用于估计瘦体重，作为肌肉减少症的替代标志物，但关于肌肉减少症对炎症性肠病手术后临床结局的影响的证据很少。本研究旨在评估磁共振小肠造影术定义的肌肉减少症与克罗恩病患者选择性回肠结肠切除术术后并发症之间的关系。为了获得腰大肌的横截面积测量值，使用徒手面积工具追踪 L4 水平每个腰大肌的边缘，将总和记录为总腰大肌面积（TPA）。腹壁的总横截面积肌肉记录为骨骼肌面积（SMA），而通过用脑脊液的平均强度归一化腰大肌强度来测量肌内脂肪。主要结局是 TPA 和 SMA 最低四分位数患者的 30 天术后并发症发生率。共纳入 31 例患者，10 例（32.25%）患者在手术后 30 天内发生术后并发症。TPA 最低四分位数的截断值为男性 11.93cm，女性 9.77cm，包括 8 例患者（25.8%），其中 5 例（62.5%）患者发生术后并发症，3 例（37.5%）Clavien-Dindo 分级≥3 并发症。SMA 最低四分位数的截断值为男性 73.49cm，女性 65.85cm，8 例中有 4 例（50%）发生术后并发症。磁共振小肠造影术可以估计腰大肌横截面积和骨骼肌面积，作为肌肉减少症的替代标志物，具有较高的观察者间一致性。
