Cha Sung Whan, Kim Sung Hyun, Baek Song Ee, Kim Kyung Sik
Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Kangwon-do, South Korea.
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Gland Surg. 2021 Sep;10(9):2622-2630. doi: 10.21037/gs-20-390.
Malnutrition leads to adverse effects on the short- and long-term prognosis in patients with periampullary diseases who underwent surgery. Nutritional risk indicators based on albumin and body weight have been developed to evaluate nutritional status and nutritional therapy efficacy, but no standard objective measurement has been devised to evaluate nutritional status during the early period after pancreaticoduodenectomy (PD). Therefore, this study aimed to assess the efficacy of total parenteral nutrition (TPN) during the early postoperative period after PD.
We analyzed 28 patients with a periampullary disease-common bile duct cancer, ampulla of Vater cancer, pancreatic head cancer, neuroendocrine tumor, chronic pancreatitis-who have undergone PD from Jan. 1, 2012 to Dec. 31, 2016. For all the patients, TPN was administered from postoperative day (POD) 1 at 25 Kcal/kg ideal body weight. Various nutritional indicators were measured such as Body mass index, nutritional risk index, protein, albumin, prealbumin, C-reactive protein. The volume of skeletal muscle area, muscle density, visceral and subcutaneous fat areas were assessed two times, preoperatively and on POD 7 by CT scan at the 3rd lumbar spine (L3) level.
Average age of the 28 study subjects (18 males and 10 females) was 63.5±9.7 years. Although there is no difference in BMI between preoperative result and POD 7, protein, albumin, and prealbumin levels were significantly lower POD 7 the preoperative (P<0.001), but CRP was higher (P<0.001), and prealbumin and CRP levels were negatively correlated (R=-0.682, P<0.01). Muscle mass increased postoperatively (P=0.02), but the amount of visceral fat decreased (P=0.00). Based on CRP, and muscle density results, muscle, visceral and subcutaneous fat masses did not change after PD.
In order to evaluate the nutritional status accurately after the hepato-biliary radical surgery, we suggest the muscle and fat mass measurement that can adjust the degree of inflammation during the early postoperative period.
营养不良会对接受手术的壶腹周围疾病患者的短期和长期预后产生不利影响。基于白蛋白和体重的营养风险指标已被开发出来，用于评估营养状况和营养治疗效果，但尚未设计出标准的客观测量方法来评估胰十二指肠切除术（PD）后早期的营养状况。因此，本研究旨在评估全胃肠外营养（TPN）在PD术后早期的疗效。
我们分析了2012年1月1日至2016年12月31日期间接受PD手术的28例壶腹周围疾病患者，包括胆总管癌、壶腹癌、胰头癌、神经内分泌肿瘤、慢性胰腺炎。所有患者从术后第1天开始接受TPN，剂量为25千卡/千克理想体重。测量了各种营养指标，如体重指数、营养风险指数、蛋白质、白蛋白、前白蛋白、C反应蛋白。通过在第3腰椎（L3）水平进行CT扫描，在术前和术后第7天对骨骼肌面积、肌肉密度、内脏和皮下脂肪面积进行了两次评估。
28例研究对象（18例男性和10例女性）的平均年龄为63.5±9.7岁。虽然术前结果与术后第7天的体重指数没有差异，但术后第7天的蛋白质、白蛋白和前白蛋白水平明显低于术前（P<0.001），但C反应蛋白更高（P<0.001），且前白蛋白和C反应蛋白水平呈负相关（R=-0.682，P<0.01）。术后肌肉量增加（P=0.02），但内脏脂肪量减少（P=0.00）。基于C反应蛋白和肌肉密度结果，PD术后肌肉、内脏和皮下脂肪量没有变化。
为了准确评估肝胆根治性手术后的营养状况，我们建议在术后早期测量肌肉和脂肪量，以调整炎症程度。
