Department of General Surgery and Transplantations, Sheba Medical Center, Tel HaShomer, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int J Colorectal Dis. 2021 Mar;36(3):543-550. doi: 10.1007/s00384-020-03799-1. Epub 2020 Nov 24.
Crohn's disease (CD) is associated with increased postoperative morbidity. Sarcopenia correlates with increased morbidity and mortality in various medical conditions. We assessed correlations of the lean body mass marker and psoas muscle area (PMA), with postoperative outcomes in CD patients undergoing gastrointestinal surgery.
We included patients with CD who underwent gastrointestinal surgery between June 2009 and October 2018 and had CT/MRI scans within 8 weeks preoperatively. PMA was measured bilaterally on perioperative imaging.
Of 121 patients, the mean age was 35.98 ± 15.07 years; 51.2% were male. The mean BMI was 21.56 ± 4 kg/m2. The mean PMA was 95.12 ± 263.2cm. Patients with postoperative complications (N = 31, 26%) had significantly lower PMA compared with patients with a normal postoperative recovery (8.5 ± 2.26 cm2 vs. 9.85 ± 2.68 cm2, P = 0.02). A similar finding was noted comparing patients with anastomotic leaks to those without anastomotic leaks (7.48 ± 0.1 cm2 vs. 9.6 ± 2.51 cm2, P = 0.04). PMA correlated with the maximum degree of complications per patient, according to the Clavien-Dindo classification (Spearman's coefficient = -0.26, P = 0.004). Patients with major postoperative complications (Clavien-Dindo ≥ 3) had lower mean PMA (8.12 ± 2.75 cm2 vs. 9.71 ± 2.57 cm2, P = 0.03). Associations were similar when stratifying by gender and operation urgency. On multivariate analysis, PMA (HR = 0.72/cm2, P = 0.02), operation urgency (HR = 3.84, P < 0.01), and higher white blood cell count (HR = 1.14, P = 0.02) were independent predictive factors for postoperative complications.
PMA is an easily measured radiographic parameter associated with postoperative complications in patients with CD undergoing bowel resection.
克罗恩病（CD）与术后发病率增加有关。肌肉减少症与各种医疗状况下的发病率和死亡率增加相关。我们评估了瘦体重标志物和腰大肌面积（PMA）与接受胃肠手术的 CD 患者术后结局的相关性。
我们纳入了 2009 年 6 月至 2018 年 10 月期间接受胃肠手术且术前 8 周内行 CT/MRI 检查的 CD 患者。在围手术期影像学上双侧测量 PMA。
121 例患者中，平均年龄为 35.98 ± 15.07 岁，51.2%为男性，平均 BMI 为 21.56 ± 4 kg/m2，平均 PMA 为 95.12 ± 263.2cm。术后并发症患者（N=31，26%）的 PMA 显著低于术后恢复正常的患者（8.5 ± 2.26 cm2 比 9.85 ± 2.68 cm2，P=0.02）。比较吻合口漏患者与无吻合口漏患者也得出了类似的发现（7.48 ± 0.1 cm2 比 9.6 ± 2.51 cm2，P=0.04）。PMA 与根据 Clavien-Dindo 分类的每位患者的最大并发症严重程度相关（Spearman 系数=-0.26，P=0.004）。术后发生严重并发症（Clavien-Dindo≥3）的患者 PMA 平均值较低（8.12 ± 2.75 cm2 比 9.71 ± 2.57 cm2，P=0.03）。按性别和手术紧急程度分层时，相关性相似。多变量分析显示，PMA（HR=0.72/cm2，P=0.02）、手术紧急程度（HR=3.84，P<0.01）和较高的白细胞计数（HR=1.14，P=0.02）是术后并发症的独立预测因素。
PMA 是一种易于测量的影像学参数，与接受肠切除术的 CD 患者的术后并发症相关。
