Chinese General Practice ›› 2023, Vol. 26 ›› Issue (32): 4031-4037.DOI: 10.12114/j.issn.1007-9572.2023.0127

• Article • Previous Articles     Next Articles

Risk Factors for Loss of Skeletal Muscle Mass and Its Correlation with Complications after Major Hepatectomy for Liver Cancer

  

  1. Department of General Surgery, the Second Affiliated Hospital of Soochow University, Suzhou 215000, China
  • Received:2023-02-06 Revised:2023-03-30 Published:2023-11-15 Online:2023-04-26
  • Contact: CAO Chun

肝癌大范围肝切除术后骨骼肌减少的危险因素及其与术后并发症的相关性研究

  

  1. 215000 江苏省苏州市,苏州大学附属第二医院普外科
  • 通讯作者: 曹春
  • 作者简介:
    作者贡献:高德康提出研究选题方向,负责资料收集和整理,并撰写论文初稿;危少华负责文章构思与设计;马孝明负责进行数据收集与整理;杜鹏负责论文的修订;邢春根负责提出选题并进行研究设计与可行性分析;曹春负责文章质量控制及审校,对文章整体负责;所有作者确认了论文的最终稿。
  • 基金资助:
    国家自然科学基金资助项目(82202369); 苏州市科技局项目(SKYD2022117); 苏州市卫健委"科教兴卫"项目(KJXW2020020)

Abstract:

Background

Major hepatectomy for liver malignancies carries with large risks. Perioperative nutritional support plays a vital role for postoperative recovery. However, there are few studies focusing on predictions of postoperative complications and prognosis using postoperative loss of skeletal muscle mass (PLSMM) in acute stage after major hepatectomy.

Objective

To identify the change inskeletal muscle index (SMI), and to investigate risk factors for PLSMM, as well as its correlation with postoperative complications after major hepatectomy for liver cancer.

Methods

A total of 97 patients who received major hepatectomy for liver cancer from Department of General Surgery, the Second Affiliated Hospital of Soochow University between July 2018 and August 2022 were included. The preoperative and postoperative day 5 skeletal muscle area at the third lumbar vertebra level was measured, respectively, using computed tomographic images. The postoperative change rate of SMI was calculated. The PLSMM was defined as the lowest tertile of the percent change in SMI, according to which the patients were divided into PLSMM and Non-PLSMM group. Baseline data, surgical and postoperative indices were collected and analyzed.

Results

SMI was decreased in 54 patients postoperatively. Thirty-two and 65 patients were assigned to the PLSMM group (SMI≤-3.59%) and Non-PLSMM groups (SMI>-3.59%), respectively. Compared with Non-PLSMM group, PLSMM group had longer operation time, more intraoperative blood loss and higher ratio of microvascular invasion (MVI) (P<0.05). Moreover, PLSMM group had longer postoperative hospital stay, higher levels of white blood cell and international normalized ratio and lower level of fibrinogen on postoperative day 5 (P<0.05). PLSMM group showed a lower incidence of overall complications (P<0.05). Multivariate Logistic regression analysis indicated that MVI〔OR=2.751, 95%CI (1.173, 6.642) 〕 and operation time >210 min〔OR=1.973, 95%CI (1.286, 4.936) 〕were risk factors associated with PLSMM (P<0.05). PLSMM〔OR=2.591, 95%CI (1.173, 6.977) 〕, preoperative myopenia〔OR=1.798, 95%CI (1.133, 3.792) 〕, operation time >210 min〔OR=2.958, 95%CI (0.918, 9.529) 〕 and blood loss >500 mL〔OR=1.003, 95%CI (1.001, 1.007) 〕 were risk factors associated with postoperative complications (P<0.05) .

Conclusion

MVI and operation time >210 min were risk factors associated with PLSMM. PLSMM was the independent predictor of postoperative complications, which negatively affected postoperative outcomes after major hepatectomy.

Key words: Liver neoplasms, Postoperative loss of skeletal muscle mass, Sarcopenia, Major hepatectomy, Complications, Root cause analysis

摘要:

背景

肝癌大范围肝切除术手术风险高,围术期营养状况对术后恢复极为重要,然而目前鲜有术后骨骼肌减少(PLSMM)预测术后并发症及预后的研究。

目的

明确肝癌大范围肝切除术后患者骨骼肌指数(SMI)变化,并探讨术后PLSMM发生的危险因素以及其与术后并发症的相关性。

方法

选取2018年7月—2022年8月因肝癌在苏州大学附属第二医院普外科接受大范围肝切除术的患者97例,通过CT影像测量术前和术后第5天第三腰椎水平的骨骼肌面积。计算术后SMI变化率,PLSMM定义为SMI变化率的最低三分位数,并以此将患者分为PLSMM组和Non-PLSMM组。收集两组患者基线资料、手术相关指标及术后指标等并进行对比分析。

结果

共54例患者术后出现SMI降低;PLSMM组32例(SMI≤-3.59%),Non-PLSMM组65例(SMI>-3.59%)。PLSMM组手术时间长于Non-PLSMM组,手术失血量多于Non-PLSMM组,微血管侵犯(MVI)发生率高于Non-PLSMM组(P<0.05)。PLSMM组术后住院时间长于Non-PLSMM组,术后第5天白细胞计数(WBC)和国际标准化比值(INR)高于Non-PLSMM组,术后第5天纤维蛋白原(FIB)水平低于Non-PLSMM组,总体并发症发生率高于Non-PLSMM组(P<0.05)。多因素Logistic回归分析结果显示,MVI〔OR=2.751,95%CI(1.173,6.642)〕及手术时间>210 min〔OR=1.973,95%CI(1.286,4.936)〕是肝癌大范围肝切除术后患者发生PLSMM的危险因素(P<0.05);并且PLSMM〔OR=2.591,95%CI(1.173,6.977)〕、术前肌少症〔OR=1.798,95%CI(1.133,3.792)〕、手术时间>210 min〔OR=2.958,95%CI(0.918,9.529)〕和失血量>500 mL〔OR=1.003,95%CI(1.001,1.007)〕是肝癌大范围肝切除术后患者发生并发症的危险因素(P<0.05)。

结论

MVI和手术时间>210 min是肝癌大范围肝切除术后PLSMM发生的危险因素,同时PLSMM是术后并发症的独立预测因子,其对预后发挥负向影响作用。

关键词: 肝肿瘤, 术后骨骼肌减少, 肌减少症, 大范围肝切除, 术后并发症, 影响因素分析