Tamai Koki, Okamura Shu, Kamakura Yu, Koh Masahiro, Hayashi Koji, Hara Akio, Katsura Yoshiteru, Hirose Hajime, Tanaka Natsumi, Ebisui Chikara, Yokouchi Hideoki, Yano Masahiko
Department of Surgery, Suita Municipal Hospital, Suita City, Osaka, Japan.
Surg Laparosc Endosc Percutan Tech. 2023 Feb 1;33(1):69-75. doi: 10.1097/SLE.0000000000001142.
In the era of laparoscopic surgery, incisional hernia (IH) remains a common complication of colorectal surgery. Various risk factors for IH have been evaluated to reduce the incidence, but the impact of nutrition on IH has not been well discussed. The aim of this study is to evaluate the relationship between nutritional status and the development of IH after laparoscopic colorectal surgery.
We retrospectively evaluated 342 colorectal cancer patients undergoing laparoscopic colectomy or proctectomy between January 2012 and December 2018. Postoperative computed tomography was used to diagnose the IH. Patient characteristics, including preoperative albumin and lymphocyte counts, were evaluated for the risk of development of IH. Further investigations were conducted regarding the impact of nutritional status on the development of IH in each patient of body mass index (BMI) under and over 25.0 kg/m 2 .
IH was observed in 37 patients (10.8%), with a median follow-up period of 48.5 months. Female [odds ratio (OR)=3.43, P <0.01], BMI ≥25 kg/m 2 (OR=2.9, P <0.01), lymphocyte count ≥1798/µL (OR=3.37, P <0.01), and operative time ≥254 minutes (OR=3.90, P <0.01) had statistically significant relationships to IH in multivariate analysis. Low albumin was related to IH in BMI ≥25 kg/m 2 ( P =0.02), but was not in BMI<25 kg/m 2 ( P =0.21). On the other hand, a high lymphocyte count was related to IH regardless of BMI (BMI ≥25 kg/m 2 : P =0.01, BMI<25 kg/m 2 : P =0.04).
A high preoperative lymphocyte count is an independent risk factor for IH, whereas a low albumin count is limited regarding predicting IH.
在腹腔镜手术时代，切口疝（IH）仍是结直肠手术的常见并发症。为降低其发生率，人们对多种IH风险因素进行了评估，但营养对IH的影响尚未得到充分讨论。本研究旨在评估腹腔镜结直肠手术后营养状况与IH发生之间的关系。
我们回顾性评估了2012年1月至2018年12月期间接受腹腔镜结肠切除术或直肠切除术的342例结直肠癌患者。术后计算机断层扫描用于诊断IH。评估患者特征，包括术前白蛋白和淋巴细胞计数，以确定IH发生风险。针对体重指数（BMI）低于和高于25.0kg/m²的每位患者，进一步研究营养状况对IH发生的影响。
37例患者（10.8%）出现IH，中位随访期为48.5个月。多因素分析显示，女性[比值比（OR）=3.43，P<0.01]、BMI≥25kg/m²（OR=2.9，P<0.01）、淋巴细胞计数≥1798/µL（OR=3.37，P<0.01）以及手术时间≥254分钟（OR=3.90，P<0.01）与IH有统计学显著关系。低白蛋白在BMI≥25kg/m²时与IH相关（P=0.02），而在BMI<25kg/m²时则不相关（P=0.21）。另一方面，无论BMI如何，高淋巴细胞计数均与IH相关（BMI≥25kg/m²：P=0.01，BMI<25kg/m²：P=0.04）。
术前高淋巴细胞计数是IH的独立危险因素，而低白蛋白计数在预测IH方面作用有限。
