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目的探讨术前营养风险评估与直肠癌前切除术后吻合口漏的相关性。方法回顾性分析2008年1月至2013年12月期间笔者所在医院321例行直肠癌前切除术患者的临床资料,采用营养风险筛查2002(NRS 2002)对入组患者术前营养风险进行评分,并通过单因素分析和多因素Logistic回归模型分析术前营养风险与术后吻合口漏的相关性。结果 321例患者术后吻合口漏发生率为5.6%(18/321)。单因素分析结果显示,NRS2002评分≥3分、临床病理分期为Ⅲ-Ⅳ期以及吻合口距肛缘距离≤5 cm是吻合口漏的危险因素(P<0.01);多因素Logistic回归分析结果显示,NRS2002评分(OR=4.125,95%CI=2.062~7.004)、临床病理分期(OR=3.334,95%CI=2.062~7.004)及吻合口距肛缘距离(OR=2.341,95%CI=2.559~15.838)是吻合口漏的独立危险因素。结论直肠癌前切除术患者术前NRS2002评分有助于预测术后吻合口漏发生风险,对于NRS2002评分≥3分的患者,应加强围手术期营养支持。
Objective To investigate the correlation between preoperative nutrition risk assessment and anastomotic leakage after resection of rectal cancer. Methods The clinical data of 321 patients undergoing rectal cancer precancerous resection from January 2008 to December 2013 were retrospectively analyzed. Nutritional risk screening 2002 (NRS 2002) was used to assess the preoperative nutritional risk , And univariate analysis and multivariate logistic regression model analysis of preoperative nutritional risk and postoperative anastomotic leakage correlation. Results The incidence of anastomotic leakage in 321 patients was 5.6% (18/321). Univariate analysis showed that the score of NRS2002≥3, the clinicopathological stage of stage Ⅲ-Ⅳ, and the distance of anastomotic anastomosis ≤5 cm were the risk factors for anastomotic leakage (P <0.01). The multivariate Logistic regression analysis showed that (OR = 4.125, 95% CI = 2.062 ~ 7.004), clinical stage (OR = 3.334, 95% CI = 2.062-7.004) and anastomotic distance from anal verge (OR = 2.341, 95% CI 2.559 ~ 15.838) is an independent risk factor for anastomotic leakage. Conclusion The preoperative NRS2002 score in patients with rectal cancer before resection is helpful to predict the risk of anastomotic leakage after operation. For patients with NRS2002 score ≥3, nutritional support should be strengthened during perioperative period.