Takeuchi Hiroki, Nakata Wataru, Matsuse Miwa, Tsujimura Go, Tsujimoto Yuichi, Tsujihata Masao, Saijo Takeshi, Ryomoto Kayoko, Momoki Chika, Habu Daiki
Department of Nutrition Management, Osaka Rosai Hospital, Sakai, Osaka 591-8025, Japan; Department of Nutritional Medicine, Graduate School of Human Life Science, Osaka Metropolitan University, Osaka 558-8585, Japan.
Department of Urology, Osaka Rosai Hospital, Sakai, Osaka 591-8025, Japan.
Clin Genitourin Cancer. 2024 Apr;22(2):360-366. doi: 10.1016/j.clgc.2023.12.005. Epub 2023 Dec 13.
Radical cystectomy and ileal conduit have a high incidence of surgical site infection. In this study, we evaluated the effects of preoperative immunonutrition on its incidence following these procedures.
We retrospectively enrolled 86 patients who underwent radical cystectomy and ileal conduit at our hospital between 2014 October and 2021 July. They were sequentially divided into the Immunonutrition group (n = 43) and Control group (n = 43). Patients in the Immunonutrition group drank 4 packs of IMPACT (Nestle, Japan) per day for 5 days before surgery. IMPACT contains arginine and eicosapentaenoic acid. We compared levels of plasma arginine and eicosapentaenoic acid before and after surgery and the rate of surgical site infection between the groups. Factors related to surgical site infection were analyzed using univariate and multivariable logistic regression analysis.
No statistically significant differences were observed in patient characteristics between the groups except for surgical operative method (P < .001) and transfusion (P = .009). Levels of plasma arginine and eicosapentaenoic acid were significantly increased the day before surgery in the immunonutrition group (P < .001). However, the levels of plasma arginine on the day after surgery did not vary significantly between the groups. The incidence of surgical site infection was significantly lower in the immunonutrition group (P = .014). Multivariate analyses showed a significant association of surgical site infection with immunonutrition (OR = 0.14, CI 0.03-0.72, P = .019) and with ASA classification (OR = 4.76, CI 1.23-18.40, P = .024).
Preoperative immunonutrition significantly reduced the incidence of surgical site infection following radical cystectomy and ileal conduit.
根治性膀胱切除术和回肠膀胱术的手术部位感染发生率较高。在本研究中，我们评估了术前免疫营养对这些手术后手术部位感染发生率的影响。
我们回顾性纳入了2014年10月至2021年7月期间在我院接受根治性膀胱切除术和回肠膀胱术的86例患者。他们被依次分为免疫营养组（n = 43）和对照组（n = 43）。免疫营养组的患者在手术前5天每天饮用4包安素（雀巢，日本）。安素含有精氨酸和二十碳五烯酸。我们比较了手术前后两组患者血浆精氨酸和二十碳五烯酸水平以及手术部位感染率。使用单因素和多因素逻辑回归分析来分析与手术部位感染相关的因素。
除手术操作方法（P <.001）和输血（P =.009）外，两组患者的特征在统计学上无显著差异。免疫营养组患者术前一天血浆精氨酸和二十碳五烯酸水平显著升高（P <.001）。然而，术后一天两组患者的血浆精氨酸水平无显著差异。免疫营养组的手术部位感染发生率显著较低（P =.014）。多因素分析显示手术部位感染与免疫营养（OR = 0.14，CI 0.03 - 0.72，P =.019）以及ASA分级（OR = 4.76，CI 1.23 - 18.40，P =.024）显著相关。
术前免疫营养显著降低了根治性膀胱切除术和回肠膀胱术后手术部位感染的发生率。
