A related study on the risk of abdominal and pelvic fat and muscle content for parastomal hernia after Miles surgery

doi:10.3877/cma.j.issn.1674-392X.2023.01.004

Abstract

Abstract:

Objective

To explore the relationship between abdominal and pelvic fat and muscle levels and PH (parastomal hernia).

Methods

A total of 43 patients with abdominal and pelvic CT undergoing Miles surgery in our hospital from January 2016 to July 2019 were retrospectively included in the analysis, and were diagnosed with PH through postoperative follow-up. Using CT post-processing software combined with the abdominal and pelvic CT scan images of preoperative patients to measure the periumbilical cross-sectional area and volume of the fat and the muscle tissue from the diaphragmatic muscle to the upper margin of the pubic bone, which were then used in statistical analysis.

Results

16 of the 43 patients developed parastomal hernias, with a total incidence of 37.21%; In univariate analysis, older age (P=0.046), higher body mass index (BMI) (P=0.036), subcutaneous fat area (SFA) (P=0.003), visceral fat area (VFA)(P=0.008), subcutaneous fat volume (SFV)(P=0.011), visceral fat volume (VFV)(P=0.003) and lower skeletal muscle volume (SMV)(P=0.009) were significant risk factors for PH. In multivariate analysis, lower SMV (P=0.026) was an independent risk factor for PH.

Conclusion

Preoperative lower abdominal and pelvic muscle content (quantified by SMV) is an independent risk factor for PH in patients with colorectal cancer Miles surgery.

Key words: Parastomal hernia, Risk factors, Body mass index, Body layer photography, X-ray computer, Skeletal muscle volume

Zehua Zhang, Shiyi Yang, Maoming Xiong, Jiawei Zhang. A related study on the risk of abdominal and pelvic fat and muscle content for parastomal hernia after Miles surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(01): 9-14.

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References 23

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组别	例数	年龄(岁)	性别[例(%)]		BMI(kg/m²)	术式[例(%)]		术后放化疗史[例(%)]		肿瘤直径(cm)	病理T分期[例(%)]		病理N分期[例(%)]
组别	例数	年龄(岁)	男	女	BMI(kg/m²)	开放	微创	有	无	肿瘤直径(cm)	T₁~T₂	T₃~T₄	N₀	N≥N₁
非造口旁疝组	27	54.03±12.34	20(74.1)	7(25.9)	22.40±2.99	14(51.9)	13(48.1)	17(63.0)	10(37.0)	4.45±1.84	6(22.2)	21(77.8)	13(48.1)	14(51.9)
造口旁疝组	16	61.81± 9.83	8(50.0)	8(50.0)	25.28±4.62	11(68.6)	5(31.3)	7(43.8)	9(56.3)	4.47±1.43	7(43.8)	9(56.3)	10(56.3)	6(37.5)
t/U/X²		-2.146	2.563		126.500	1.179		1.504		215.500	2.207		0.832
P值		0.038^t	0.109^x		0.024^*	0.278^x		0.220^x		0.990^*	0.137^x		0.362^x
组别	例数	SFA(cm²)	VFA(cm²)	SMA(cm²)	TFA(cm²)	SMA/TLA	VFV(cm³)
非造口旁疝组	27	113.08±49.42	73.69±37.18	143.65±24.84	186.77±72.68	0.33±0.06	1909.23±946.29
造口旁疝组	16	194.66±92.00	117.87±53.81	135.55±24.88	312.54±123.78	0.25±0.05	3766.12±1741.76
t/U值		77.000	106.000	1.033	73.000	4.647	-3.934
P值		<0.001^*	0.006^*	0.309^t	<0.001^*	<0.001^t	0.001^t
组别	例数	SFV(cm³)	TIV(cm³)	SMV(cm³)	TAV(cm³)	TFV(cm³)
非造口旁疝组	27	4032.54±2022.25	6977.89±1515.17	5430.70±1236.99	18 511.30±4192.27	5941.78±2791.52
造口旁疝组	16	6708.08±3689.40	8685.02±3063.48	4400.80± 734.09	22 027.25±5780.27	10 474.20±4698.85
t/U值		89.000	118.000	98.000	113.500	78.000
P值		0.001^*	0.014^*	0.003^*	0.010*	0.001^*

组别	例数	年龄(岁)	性别[例(%)]		BMI(kg/m²)	术式[例(%)]		术后放化疗史[例(%)]		肿瘤直径(cm)	病理T分期[例(%)]		病理N分期[例(%)]
组别	例数	年龄(岁)	男	女	BMI(kg/m²)	开放	微创	有	无	肿瘤直径(cm)	T₁~T₂	T₃~T₄	N₀	N≥N₁
非造口旁疝组	27	54.03±12.34	20(74.1)	7(25.9)	22.40±2.99	14(51.9)	13(48.1)	17(63.0)	10(37.0)	4.45±1.84	6(22.2)	21(77.8)	13(48.1)	14(51.9)
造口旁疝组	16	61.81± 9.83	8(50.0)	8(50.0)	25.28±4.62	11(68.6)	5(31.3)	7(43.8)	9(56.3)	4.47±1.43	7(43.8)	9(56.3)	10(56.3)	6(37.5)
t/U/X²		-2.146	2.563		126.500	1.179		1.504		215.500	2.207		0.832
P值		0.038^t	0.109^x		0.024^*	0.278^x		0.220^x		0.990^*	0.137^x		0.362^x
组别	例数	SFA(cm²)	VFA(cm²)	SMA(cm²)	TFA(cm²)	SMA/TLA	VFV(cm³)
非造口旁疝组	27	113.08±49.42	73.69±37.18	143.65±24.84	186.77±72.68	0.33±0.06	1909.23±946.29
造口旁疝组	16	194.66±92.00	117.87±53.81	135.55±24.88	312.54±123.78	0.25±0.05	3766.12±1741.76
t/U值		77.000	106.000	1.033	73.000	4.647	-3.934
P值		<0.001^*	0.006^*	0.309^t	<0.001^*	<0.001^t	0.001^t
组别	例数	SFV(cm³)	TIV(cm³)	SMV(cm³)	TAV(cm³)	TFV(cm³)
非造口旁疝组	27	4032.54±2022.25	6977.89±1515.17	5430.70±1236.99	18 511.30±4192.27	5941.78±2791.52
造口旁疝组	16	6708.08±3689.40	8685.02±3063.48	4400.80± 734.09	22 027.25±5780.27	10 474.20±4698.85
t/U值		89.000	118.000	98.000	113.500	78.000
P值		0.001^*	0.014^*	0.003^*	0.010*	0.001^*

变量	OR(95% CI)	P值
开放/微创	2.043(0.557~7.488)	0.281
性别	0.350(0.095~1.290)	0.115
病理N分期N₀/N≥N₁	1.795(0.508~6.344)	0.364
病理T分期T₁~T₂/T₃~T₄	2.722(0.712~10.409)	0.143
肿瘤直径	1.008(0.694~1.462)	0.969
年龄	1.065(1.001~1.132)	0.046
术后有无放化疗史	2.186(0.620~7.700)	0.224
BMI	1.270(1.016~1.587)	0.036
SFA	1.023(1.008~1.039)	0.003
VFA	1.022(1.006~1.038)	0.008
SMA	0.986(0.961~1.012)	0.301
SFV	1.000(1.000~1.001)	0.011
VFV	1.001(1.000~1.002)	0.003
SMV	0.999(0.998~1.000)	0.009

变量	OR(95% CI)	P值
开放/微创	2.043(0.557~7.488)	0.281
性别	0.350(0.095~1.290)	0.115
病理N分期N₀/N≥N₁	1.795(0.508~6.344)	0.364
病理T分期T₁~T₂/T₃~T₄	2.722(0.712~10.409)	0.143
肿瘤直径	1.008(0.694~1.462)	0.969
年龄	1.065(1.001~1.132)	0.046
术后有无放化疗史	2.186(0.620~7.700)	0.224
BMI	1.270(1.016~1.587)	0.036
SFA	1.023(1.008~1.039)	0.003
VFA	1.022(1.006~1.038)	0.008
SMA	0.986(0.961~1.012)	0.301
SFV	1.000(1.000~1.001)	0.011
VFV	1.001(1.000~1.002)	0.003
SMV	0.999(0.998~1.000)	0.009

变量	模型1		模型2		模型3
变量	OR(95% CI)	P值	OR(95% CI)	P值	OR(95% CI)	P值
年龄	1.132(1.016~1.261)	0.024	1.022(0.909~1.150)	0.712	1.119(0.994~1.261)	0.062
BMI	0.823(0.485~1.397)	0.470	1.343(0.554~3.258)	0.514	1.291(0.727~2.290)	0.383
SFA	1.039(1.010~1.068)	0.008			1.031(0.999~1.064)	0.057
VFA	1.018(0.987~1.050)	0.256
SMA	0.980(0.938~1.023)	0.353
SFV			1.000(0.999~1.001)	0.955
VFV			1.001(1.000~1.003)	0.103
SMV			0.998(0.996~1.000)	0.014	0.998(0.997~1.000)	0.022

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