肌肉减少症预测结直肠癌术后切口疝发生的应用研究

doi:10.3877/cma.j.issn.1674-392X.2024.06.009

目的

探讨肌肉减少症对结直肠癌术后切口疝发生的影响及预测价值。

方法

纳入2017 年1 月1 日至2019 年12 月31 日，因结直肠恶性肿瘤于西湖大学医学院附属杭州市第一人民医院行结直肠癌根治术的患者150 例，回顾分析其临床资料。根据术后是否发生切口疝分为切口疝组（IH）和非切口疝组（NIH），通过勾画患者术前CT 影像第3 腰椎（L3）水平不同组织的面积，获得术前的肌肉量。应用Cox 回归分析肌肉减少症及其他临床因素对结直肠癌患者术后切口疝发生的影响，并根据多因素分析绘制列线图模型预测结直肠癌患者术后切口疝的发生风险。

结果

在随访期内共有26例（17.3%）结直肠癌患者术后出现了切口疝，IH 组患者L3 水平的骨骼肌指数为（44.7±7.6）cm²/m²，明显低于NIH 组（49.1±9.0）cm²/m²，差异有统计学意义（t=－2.600，P=0.013）。在多因素分析中，肌肉减少症（HR=3.709，P=0.004）、直肠癌（HR=3.982，P=0.002）和开腹手术（HR=2.404，P=0.043）为结直肠癌术后出现切口疝的独立危险因素，并依此建立结直肠癌术后切口疝发生的预测模型。

结论

肌肉减少症、直肠癌、开腹手术是结直肠恶性肿瘤患者术后切口疝发生的独立危险因素，可用于评估术后切口疝的发生风险。

关键词: 切口疝, 结直肠癌, 肌肉减少症, 预后

Objective

To investigate the impact and predictive value of sarcopenia on the occurrence of incisional hernia after colorectal cancer surgery.

Methods

A retrospective analysis was conducted on the clinical data of 150 patients who underwent radical surgery for colorectal cancer at Hangzhou First People's Hospital, Affiliated with the School of Medicine, Westlake University, from January 1, 2017, to December 31, 2019.Patients were divided into the incision hernia group (IH) and the non-incision hernia group (NIH) according to postoperative imaging findings.The preoperative muscle mass of patients was obtained by delineating the areas of different tissues at the level of the third lumbar vertebra (L3) in CT images.Cox regression was used to analyze the influence of sarcopenia and other clinical factors on postoperative incisional hernia in patients with colorectal cancer, and a nomogram model was established according to multivariate analysis to predict the risk of postoperative incisional hernia in patients with colorectal cancer.

Results

During the follow-up period, 26 patients (17.3%) developed incisional hernia after operation, and the skeletal muscle index (SMI) of L3 level in the IH group was(44.7±7.6) cm²/m², which was significantly lower than that in NIH group (49.1±9.0) cm²/m², the difference was statistically significant (t=-2.600, P=0.013).In multivariate analysis, it was found that sarcopenia(HR=3.709, P=0.004), rectal cancer (HR=3.982, P=0.002) and laparotomy (HR=2.404, P=0.043) were independent risk factors for the prognosis of postoperative incisional hernia in colorectal cancer, and a prediction model of postoperative incisional hernia in colorectal cancer was established accordingly.

Conclusion

Sarcopenia, rectal cancer and laparotomy are independent risk factors for postoperative incisional hernia in patients with colorectal cancer, which can be used to evaluate the incidence of postoperative incisional hernia.

Key words: Incisional hernia, Colorectal cancer, Sarcopenia, Prognosis

图1 结直肠癌患者纳入流程图注：TaTME 经肛全直肠系膜切除术。

图2 结直肠癌患者术前第3 腰椎截面的CT 图像

表1 150 例结直肠癌患者的临床特征

临床特征	切口疝(n=26)	非切口疝(n=124)	t/χ²值	P值
性别[例(%)]			5.572^a	0.018
男性	11(42.3)	83(66.9)
女性	15(57.7)	41(33.1)
年龄(岁, $\overset{ˉ}{x}$ ±s)	65.8±10.7	64.1±11.2	0.751	0.457
身高(cm, $\overset{ˉ}{x}$ ±s)	162.9±9.4	164.9±7.5	-1.019	0.316
体重(kg, $\overset{ˉ}{x}$ ±s)	60.2±11.4	62.9±10.8	-1.113	0.273
体重指数(kg/m², $\overset{ˉ}{x}$ ±s ))	22.6±3.3	23.1±3.2	-0.715	0.479
吸烟[例(%)]	5(19.2)	38(30.6)	1.369^a	0.242
糖尿病[例(%)]	1(3.8)	21(16.9)	2.942^a	0.158
腹腔镜手术[例(%)]	17(65.4)	104(83.8)	5.139^a	0.023
疾病类型[例(%)]			6.738^a	0.009
直肠癌	19(73.1)	58(46.8)
结肠癌	7(26.9)	70(56.5)
骨骼肌面积(cm², $\overset{ˉ}{x}$ ±s)	119.0±24.5	134.3±29.7	-2.801	0.008
骨骼肌指数(cm²/m², $\overset{ˉ}{x}$ ±s)	44.7±7.6	49.1±9.0	-2.600	0.013
皮下脂肪面积(cm², $\overset{ˉ}{x}$ ±s)	117.8±59.1	98.2±49.8	1.577	0.124
内脏脂肪面积(cm², $\overset{ˉ}{x}$ ±s)	103.3±62.5	116.6±69.7	-0.965	0.341

表1 150 例结直肠癌患者的临床特征

临床特征	切口疝(n=26)	非切口疝(n=124)	t/χ²值	P值
性别[例(%)]			5.572^a	0.018
男性	11(42.3)	83(66.9)
女性	15(57.7)	41(33.1)
年龄(岁, $\overset{ˉ}{x}$ ±s)	65.8±10.7	64.1±11.2	0.751	0.457
身高(cm, $\overset{ˉ}{x}$ ±s)	162.9±9.4	164.9±7.5	-1.019	0.316
体重(kg, $\overset{ˉ}{x}$ ±s)	60.2±11.4	62.9±10.8	-1.113	0.273
体重指数(kg/m², $\overset{ˉ}{x}$ ±s ))	22.6±3.3	23.1±3.2	-0.715	0.479
吸烟[例(%)]	5(19.2)	38(30.6)	1.369^a	0.242
糖尿病[例(%)]	1(3.8)	21(16.9)	2.942^a	0.158
腹腔镜手术[例(%)]	17(65.4)	104(83.8)	5.139^a	0.023
疾病类型[例(%)]			6.738^a	0.009
直肠癌	19(73.1)	58(46.8)
结肠癌	7(26.9)	70(56.5)
骨骼肌面积(cm², $\overset{ˉ}{x}$ ±s)	119.0±24.5	134.3±29.7	-2.801	0.008
骨骼肌指数(cm²/m², $\overset{ˉ}{x}$ ±s)	44.7±7.6	49.1±9.0	-2.600	0.013
皮下脂肪面积(cm², $\overset{ˉ}{x}$ ±s)	117.8±59.1	98.2±49.8	1.577	0.124
内脏脂肪面积(cm², $\overset{ˉ}{x}$ ±s)	103.3±62.5	116.6±69.7	-0.965	0.341

图3 结直肠癌患者术后切口疝发生的时间曲线图

图4 单因素Cox 回归分析结直肠癌术后切口疝发生的危险因素注：BMI 体重指数。

图5 不同因素对结直肠癌患者术后切口疝发生的影响注：5A 肌肉减少症对术后切口疝发生的影响；5B 性别对术后切口疝发生的影响；5C 肠癌类型对术后切口疝发生的影响；5D 手术方式对术后切口疝发生的影响。

图6 影响结直肠癌患者骨骼肌指数的相关因素注：6A 不同性别骨骼肌指数的差异；6B 骨骼肌指数与体重指数的相关性，BMI 体重指数；6C 骨骼肌指数与年龄的相关性。

图7 多因素Cox 回归分析结直肠癌术后切口疝发生的危险因素

图8 利用是否合并有肌肉减少症、手术方式、是否为结肠癌构建列线图模型预测结直肠癌术后切口疝的发生情况注：SMI 骨骼肌指数。

[1]	Itatsu K, Yokoyama Y, Sugawara G, et al.Incidence of and risk factors for incisional hernia after abdominal surgery[J].Br J Surg,2014, 101(11): 1439-1447.
[2]	Jensen KK, Nordholm-Carstensen A, Krarup PM, et al.Incidence of Incisional Hernia Repair After Laparoscopic Compared to Open Resection of Colonic Cancer: A Nationwide Analysis of 17, 717 Patients[J].World J Surg, 2020, 44(5): 1627-1636.
[3]	van Silfhout L, Leenders LAM, Heisterkamp J, et al.Recurrent incisional hernia repair: surgical outcomes in correlation with body-mass index[J].Hernia, 2021, 25(1): 77-83.
[4]	De Robles MS, Bakhtiar A, Young CJ.Obesity is a significant risk factor for ileostomy site incisional hernia following reversal[J].ANZ J Surg, 2019, 89(4): 399-402.
[5]	Alizai PH, Andert A, Lelaona E, et al.Impact of obesity on postoperative complications after laparoscopic and open incisional hernia repair - A prospective cohort study[J].Int J Surg, 2017, 48:220-224.
[6]	Aquina C, Rickles A, Probst C, et al.Visceral obesity, not elevated BMI, is strongly associated with incisional hernia after colorectal surgery[J].Dis Colon Rectum, 2015, 58(2): 220-227.
[7]	Baastrup NN, Jensen KK, Christensen JK, et al.Visceral obesity is a predictor of surgical site occurrence and hernia recurrence after open abdominal wall reconstruction[J].Hernia, 2022, 26(1): 149-155.
[8]	van Rooijen MMJ, Kroese LF, van Vugt JLA, et al.Sarcomania? The Inapplicability of Sarcopenia Measurement in Predicting Incisional Hernia Development[J].World J Surg, 2019, 43(3): 772-779.
[9]	Clark ST, Malietzis G, Grove TN, et al.The emerging role of sarcopenia as a prognostic indicator in patients undergoing abdominal wall hernia repairs: a systematic review of the literature[J].Hernia, 2020, 24(6): 1361-1370.
[10]	Chen LK, Woo J, Assantachai P, et al.Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment[J].J Am Med Dir Assoc, 2020, 21(3): 300-307 e2.
[11]	Lu D, Lin Z, Wang R, et al.Multi-omics profiling reveals Chitinase-3-like protein 1 as a key mediator in the crosstalk between sarcopenia and liver cancer[J].Redox Biol, 2022, 58: 102538.
[12]	He J, Luo W, Huang Y, et al.Sarcopenia as a prognostic indicator in colorectal cancer: an updated meta-analysis[J].Front Oncol, 2023,13: 1247341.
[13]	谢雅, 闫文锋, 夏晓博, 等.肌少症对食管胃结合部腺癌患者生命质量的影响[J].中华消化外科杂志, 2023, 22(11): 1330-1336.
[14]	Taylor GW, Jayne DG, Brown SR, et al.Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial[J].Br J Surg, 2010, 97(1): 70-78.
[15]	Andersen P, Erichsen R, Froslev T, et al.Open versus laparoscopic rectal cancer resection and risk of subsequent incisional hernia repair and paracolostomy hernia repair: a nationwide population-based cohort study[J].Surg Endosc, 2018, 32(1): 134-144.
[16]	Udayasiri DK, Skandarajah A, Hayes IP.Laparoscopic Compared With Open Resection for Colorectal Cancer and Long-term Incidence of Adhesional Intestinal Obstruction and Incisional Hernia: A Systematic Review and Meta-analysis[J].Dis Colon Rectum, 2020,63(1): 101-112.
[17]	Bhardwaj P, Huayllani MT, Olson MA, et al.Year-Over-Year Ventral Hernia Recurrence Rates and Risk Factors[J].JAMA Surg, 2024,159(6): 651-658.

[1]	许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[2]	高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[3]	李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[4]	梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[5]	张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[6]	刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[7]	王国强, 张纲, 唐建坡, 张玉国, 杨永江. LINC00839 调节miR-17-5p/WEE1 轴对结直肠癌细胞增殖、凋亡和迁移的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 491-499.
[8]	孙晗, 于冰, 武侠, 周熙朗. 基于循环肿瘤DNA 甲基化的结直肠癌筛查预测模型的构建与验证[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 500-506.
[9]	陈倩倩, 袁晨, 刘基, 尹婷婷. 多层螺旋CT 参数、癌胚抗原、错配修复基因及病理指标对结直肠癌预后的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 507-511.
[10]	曾明芬, 王艳. 急性胰腺炎合并脂肪肝患者CT 与彩色多普勒超声诊断参数与其病情和预后的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 531-535.
[11]	沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[12]	王湛, 李文坤, 杨奕, 徐芳, 周敏思, 苏珈仪, 王亚丹, 吴静. 炎症指标在早发性结直肠肿瘤中的应用[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 802-810.
[13]	刘春峰, 徐朝晖, 施红伟, 陈瑢, 马腾飞, 李鹏飞, 袁蓉, 陈建荣, 徐爱明. 机械通气患者肌肉减少症的诊断及其对预后的影响[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 820-825.
[14]	王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15]	郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application of sarcopenia in predicting incisional hernia after colorectal cancer surgery

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application of sarcopenia in predicting incisional hernia after colorectal cancer surgery