肌肉减少症对胰十二指肠切除术后临床结局影响的Meta分析
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1.滨州医学院附属医院,肝胆外科,山东 滨州 256600;2.滨州医学院附属医院,临床营养科,山东 滨州 256600

作者简介:

马金栋,滨州医学院附属医院硕士研究生,主要从事外科临床营养方面的研究。

基金项目:

山东省临床重点专科建设基金资助项目(SLCZDZK-0701);山东省胆胰肿瘤精品特色专科建设基金资助项目(SLCZDZK-2401)。


Meta-analysis of influence of sarcopenia on clinical outcomes after pancreaticoduodenectomy
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1.Department of Hepatobiliary Surgery, Binzhou Medical University Hospital, Binzhou, Shandong 256600, China;2.Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou, Shandong 256600, China

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    摘要:

    背景与目的 肌肉减少症可导致机体四肢功能障碍、生活质量下降、死亡等不良事件风险增加。关于肌肉减少症对胰十二指肠切除术(PD)患者影响的研究较少,结论也不一致。本研究系统评价肌肉减少症对接受PD术患者术后临床结局的影响,以期通过有效干预来改善临床结局。方法 利用PubMed、Embase、Cochrane Library、CNKI、维普、万方数据库检索相关文献,检索时间为建库至2022年6月1日。由2名研究者独立筛选文献、提取资料并评价纳入研究的质量和偏倚风险后,采用RevMan 5.3软件对数据进行分析。结果 纳入14项研究,共计2 198例患者,其中肌肉减少症组737例,非肌肉减少症组1 461例,均为队列研究。Meta分析结果显示,两组的手术时间和伤口感染、尿路感染、胆汁漏、术后出血等并发症发生率均无明显差异(均P>0.05);与非肌肉减少症组患者比较,肌肉减少症组患者术前BMI(WMD=-1.22,95% CI=-1.82~0.62,P<0.001)、术前白蛋白水平(WMD=-0.30,95% CI=-0.41~0.19,P<0.001)均较低;术中出血量较多(WMD=88.12,95% CI=6.94~169.31,P<0.05);术后总体并发症(OR=3.53,95% CI=2.52~4.94,P<0.001)、Clavien-Dindo ≥3级并发症(OR=1.57,95% CI=1.17~2.12,P=0.003)、菌血症(OR=4.46,95% CI=1.42~13.98,P=0.01)、肺炎(OR=2.07,95% CI=1.31~3.25,P=0.002)、胰瘘(OR=1.34,95% CI=1.05~1.72,P=0.02)发生率较高;住院时间延长(OR=3.18,95% CI=1.97~4.39,P<0.001),病死率增加(OR=3.17,95% CI=1.55~6.50,P=0.002)。结论 PD术患者术前合并肌肉减少症的比例较高。合并肌肉减少症对患者的临床结局有不利影响,并发症发生率和病死率增加,住院时间延长。

    Abstract:

    Background and Aims Sarcopenia can lead to an increased risk of adverse events such as limb dysfunction, decreased quality of life, and death. Studies on the influences of sarcopenia on patients undergoing pancreaticoduodenectomy (PD) are scarce and the findings are inconsistent. This study was conducted to systematically evaluate the effects of sarcopenia on postoperative clinical outcomes in patients undergoing PD to improve clinical outcomes through effective interventions.Methods Relevant literature was searched using PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang databases from the time of database inception to June 1, 2022. After literature screening, information extraction and evaluation of the quality and risk of bias of the included studies by two independent investigators, the data were analyzed using RevMan 5.3 software.Results Fourteen studies with a total of 2 198 patients were included, with 737 patients in the sarcopenic group and 1 461 patients in the non-sarcopenic group, all of which were cohort studies. Meta-analysis showed that there were no significant differences in operative time and incidence rates of wound infection, urinary tract infection, biliary fistula, and postoperative bleeding between the two groups (all P>0.05); in the sarcopenic group compared with the non-sarcopenic group, the preoperative BMI value (WMD=-1.22, 95% CI=-1.82-0.62, P<0.001) and preoperative albumin level (WMD=-0.30, 95% CI=-0.41-0.19, P<0.001) were lower, intraoperative blood loss was higher (WMD=88.12, 95% CI=6.94-169.31, P<0.05), the incidence rates of overall postoperative complications (OR=3.53, 95% CI=2.52-4.94, P<0.001), complications graded Clavien-Dindo ≥3 (OR=1.57, 95% CI=1.17-2.12, P=0.003), bacteremia (OR=4.46, 95% CI=1.42-13.98, P=0.01), pneumonia (OR=2.07, 95% CI=1.31-3.25, P=0.002), and pancreatic fistula (OR=1.34, 95% CI=1.05-1.72, P=0.02) were higher; the hospital stay was prolonged (OR=3.18, 95% CI=1.97-4.39, P<0.001), and mortality was increased (OR=3.17,95% CI=1.55-6.50,P=0.002).Conclusion There is a high proportion of patients undergoing PD with preoperative comorbid sarcopenia. The concomitant sarcopenia has a detrimental influence on the clinical outcomes of patients, as evidenced by increased complication and mortality rates and lengthened hospital stay.

    表 9 肌肉减少症组和非肌肉减少症组病死的比较Table 9 Comparison of deaths in sarcopenic group and non-sarcopenic group
    表 6 肌肉减少症组和非肌肉减少症组术后总体并发症及C-D≥3级并发症比较Table 6 Comparison of overall postoperative complications and grade C-D ≥3 complications between sarcopenic group and non-sarcopenic group
    表 3 纳入研究的质量评价Table 3 Quality evaluation of included studies
    表 7 肌肉减少症组和非肌肉减少症组术后其他并发症的比较Table 7 Comparison of other postoperative complications between sarcopenic group and non-sarcopenic group
    图1 文献筛选流程Fig.1 Flow chart of literature search strategy
    图2 C-D≥3级并发症的漏斗图Fig.2 The funnel plot of C-D ≥3 complications
    图1 文献筛选流程Fig.1 Flow chart of literature search strategy
    图2 C-D≥3级并发症的漏斗图Fig.2 The funnel plot of C-D ≥3 complications
    表 2 纳入研究的基本特征(续)Table 2 The general characteristics of the included studies (continued)
    表 1 纳入研究的基本特征Table 1 The general characteristics of the included studies
    表 4 肌肉减少症组和非肌肉减少症组术前营养指标比较Table 4 Comparison of preoperative nutritional indicators between sarcopenic and non-sarcopenic groups
    表 8 肌肉减少症组和非肌肉减少症组住院时间的比较Table 8 Comparison of length of stay between the sarcopenic group and non-sarcopenic group
    表 5 肌肉减少症组和非肌肉减少症组术中指标比较Table 5 Comparison of intraoperative varbales between sarcopenic group and non-sarcopenic group
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马金栋,焦向飞,蔡婷婷,冀海斌,陈强谱.肌肉减少症对胰十二指肠切除术后临床结局影响的Meta分析[J].中国普通外科杂志,2022,31(9):1135-1144.
DOI:10.7659/j. issn.1005-6947.2022.09.002

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  • 收稿日期:2022-06-15
  • 最后修改日期:2022-09-08
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  • 在线发布日期: 2022-09-30