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目的探讨术前肝门部胆管癌患者发生营养不良的比例,分析营养不良的相关因素及营养不良与肝门部胆管癌术后并发症的关系。方法选取山西医科大学附属人民医院普外科在2000年1月1日—2015年1月1日期间收治的可根治性切除的53例肝门部胆管癌患者,术前根据患者主观营养评估法(PG-SGA)评分分为营养良好组(PG-SGA<3分)及营养不良组(PG-SGA≥4分),应用χ~2检验分析临床资料及营养不良与术后并发症之间的关系。结果通过PG-SGA营养评估,29例(54.7%)肝门部胆管癌患者术前存在营养不良,其发生营养不良与年龄、黄疸持续时间、~(13)C-美沙西丁呼气试验肝功能分级和TNM分期等因素有关,P均<0.05;而与患者性别、肿瘤Bismuth-Corlett分型、BMI、术前白蛋白、肝功能Child分级等因素无关,P均>0.05。术前存在营养不良未能进行营养治疗组术后并发症的发生率显著高于营养良好组,差异有统计学意义(χ~2=4.201,P=0.040),而术前存在营养不良同时进行营养治疗组术后并发症的发生率与营养良好组差异无统计学意义(χ~2=0.438,P=0.508)。结论肝门部胆管癌患者中术前发生营养不良的比例极高,对营养不良患者围手术期给予营养治疗能够有效降低术后并发症的发生率。
Objective To investigate the incidence of malnutrition in patients with preoperative hilar cholangiocarcinoma and to analyze the related factors of malnutrition and the relationship between malnutrition and postoperative complications of hilar cholangiocarcinoma. Methods 53 patients with hilar cholangiocarcinoma who underwent radical resection admitted to Department of General Surgery, People’s Hospital Affiliated to Shanxi Medical University between January 1, 2000 and January 1, 2015 were selected according to subjective nutritional assessment PG-SGA) were divided into two groups: healthy group (PG-SGA <3 points) and malnutrition group (PG-SGA≥4 points) .χ2 test was used to analyze clinical data and the correlation between malnutrition and postoperative complications relationship. Results By PG-SGA nutrition assessment, 29 cases (54.7%) of patients with hilar cholangiocarcinoma had preoperative malnutrition, malnutrition and age, duration of jaundice, ~ (13) C-methacetin breath test liver Functional classification and TNM stage, all P <0.05; however, there was no correlation with gender, tumor Bismuth-Corlett classification, BMI, preoperative albumin and liver function Child grading. Preoperative malnutrition was not nutrition treatment group, the incidence of postoperative complications was significantly higher than that of nourished group, the difference was statistically significant (χ ~ 2 = 4.201, P = 0.040), while the preoperative existence of malnutrition at the same time No significant difference was found between the rate of postoperative complications and the nutrition group (χ ~ 2 = 0.438, P = 0.508). Conclusion The incidence of malnutrition in patients with hilar cholangiocarcinoma is extremely high. Perioperative nutritional therapy for malnourished patients can effectively reduce the incidence of postoperative complications.