术前营养支持和康复治疗对胰十二指肠切除术患者的影响。
Impact of preoperative nutritional support and rehabilitation therapy in patients undergoing pancreaticoduodenectomy.
作者信息
Tsukagoshi Mariko, Harimoto Norifumi, Araki Kenichiro, Kubo Norio, Watanabe Akira, Igarashi Takamichi, Ishii Norihiro, Yamanaka Takahiro, Hagiwara Kei, Hoshino Kouki, Muranushi Ryo, Yajima Toshiki, Wada Naoki, Shirabe Ken
机构信息
Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi Gunma, 371-8511, Japan.
Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi Gunma, 371-8511, Japan.
出版信息
Int J Clin Oncol. 2021 Sep;26(9):1698-1706. doi: 10.1007/s10147-021-01958-0. Epub 2021 Jun 4.
BACKGROUND
Sarcopenia is closely associated with morbidity after pancreatic surgery. We investigated the impact of preoperative nutritional support and rehabilitation on patients undergoing pancreaticoduodenectomy.
METHODS
This was a retrospective analysis of 101 patients who underwent pancreaticoduodenectomy. Skeletal muscle (SM) loss was defined using the SM index (cutoff level: 42 cm/m in men and 38 cm/m in women). A total of 33 and 30 patients received preoperative nutrition and prehabilitation, respectively. The neutrophil-to-lymphocyte ratio (NLR), Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS) values were calculated during the first visit and immediately before surgery.
RESULTS
SM loss was present in 65 of 101 patients and was significantly correlated with female sex, older age, lower body mass index, and low PNI. Preoperative nutritional support and prehabilitation prevented the decrease in PNI values in patients with SM loss. The NLR significantly improved in patients with SM loss who received nutritional support and prehabilitation. In patients with SM loss, the lack of preoperative nutrition and prehabilitation was an independent risk factor for postoperative pancreatic fistula.
CONCLUSIONS
Preoperative nutritional support and prehabilitation may reduce the incidence of pancreatic fistula in patients with SM loss and improve the surgical outcomes of patients undergoing pancreaticoduodenectomy.
背景
肌肉减少症与胰腺手术后的发病率密切相关。我们研究了术前营养支持和康复对接受胰十二指肠切除术患者的影响。
方法
这是一项对101例行胰十二指肠切除术患者的回顾性分析。骨骼肌（SM）丢失通过SM指数定义（临界值：男性为42 cm/m，女性为38 cm/m）。分别有33例和30例患者接受了术前营养支持和预康复。在首次就诊时和手术前即刻计算中性粒细胞与淋巴细胞比值（NLR）、预后营养指数（PNI）和改良格拉斯哥预后评分（mGPS）值。
结果
101例患者中有65例存在SM丢失，且与女性、高龄、较低的体重指数和低PNI显著相关。术前营养支持和预康复可防止SM丢失患者的PNI值下降。接受营养支持和预康复的SM丢失患者的NLR显著改善。在SM丢失患者中，缺乏术前营养支持和预康复是术后胰瘘的独立危险因素。
结论
术前营养支持和预康复可能降低SM丢失患者的胰瘘发生率，并改善接受胰十二指肠切除术患者的手术结局。
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