摘要
目的探讨改良衰弱指数(the 5-factor modified frailty index,mFI-5)预测老年腹腔镜肝切除(laparoscopic hepatectomy,LH)病人术后并发症的临床价值,为病人的围手术期综合管理提供参考依据。方法回顾性分析2017年10月至2021年12月间陆军军医大学第二附属医院收治的90例年龄≥65岁、接受LH的肝细胞癌(hepatocellular carcinoma,HCC)病人的临床资料。收集病人人口统计学资料、手术相关信息、mFI-5评分变量及术后并发症信息。根据mFI-5评分分为衰弱组(mFI-5≥2分)与非衰弱组(mFI-5<2分)。术后并发症包括胆漏、出血、肺部感染、肝衰竭。比较两组病人术后并发症的发生情况。采用SPSS(26.0版)软件进行数据分析,以二分类多因素Logistic回归分析探讨衰弱对老年LH术后并发症的预测作用。结果衰弱组为26例(28.89%),非衰弱组为64例(71.11%)。两组病人年龄、体质量指数(BMI)、术前血清白蛋白差异均有统计学意义(均P<0.05)。在mFI-5组成因素的比较上,衰弱组与非衰弱组在慢性阻塞性肺疾病或慢性肺炎病史、非独立功能状态、2型糖尿病病史、术前30 d内充血性心力衰竭病史以及需要药物治疗的高血压病史5个方面的差异均有统计学意义(均P<0.05)。将年龄、性别、BMI、美国麻醉医师协会(ASA)分级、术前血清白蛋白,切除范围纳入多因素Logistic回归分析,结果显示:衰弱组LH病人出现住院时间延长的风险[OR=3.789,95%CI(1.167,12.300),P=0.027],术后并发症的风险较非衰弱组显著增高[OR=3.617,95%CI(1.114,11.745),P=0.032]。对各并发症分别分析,结果显示:mFI-5≥2分是术后肝衰竭[OR=8.979,95%CI(1.261,63.950),P=0.028]及肺部感染[OR=5.392,95CI%(1.102,26.39),P=0.038]的独立危险因素,而并不是术后出血及胆漏的危险因素。结论mFI-5是预测老年LH病人术后并发症的有效评估工具,mFI-5评分≥2分可作为预测术后并发症的有效指标。
Objective To explore the efficacy of 5-factor modified frailty index(mFI-5)for predicting the occurrence of postoperative complications of laparoscopic hepatectomy(LH)in elders.Methods From October 2017 to December 2021,clinical data were retrospectively reviewed for 90 hepatocellular carcinoma(HCC)patients aged 65 years or older undergoing LH.Demographic profiles,surgery-related findings,mFI-5 score variables and postoperative complications were collected.According to the score of mFI-5,they were divided into two groups of frailty(mFI-5≥2)and non-frailty(mFI-5<2).Postoperative complications included bile leakage,hemorrhage,lung infection and liver failure.SPSS 26.0 software was employed for data analysis and binary Logistic regression analysis for examining the predictive effect of frailty on postoperative complications.Results There were 26 cases(28.89%)in fateful group and 64 cases(71.11%)in non-fateful group.Significant inter-group differences existed in age,body mass index(BMI)and preoperative serum albumin(all P<0.05).In comparison with the components of mFI-5,statistically significant inter-group differences existed in history of chronic obstructive pulmonary disease.chronic pneumonia,independent functional status,history of type 2 diabetes,history of congestive heart failure within 30 days pre-operation and history of hypertension requiring medication(all P<0.05).Multivariate Logistic regression analysis indicated that,after adjusting for age,gender,BMI,American Society of Anesthesiologists(ASA)grade,preoperative serum albumin and surgical scope,LH patients had longer hospital stay in asthenic group[OR=3.789,95%CI(1.167,12.300),P=0.027]and the risk of postoperative complications[OR=3.617,95%CI(1.114,11.745),P=0.032]were significantly higher than those in non-frail group and the difference was statistically significant.The results indicated that mFI-5≥2 was an independent risk factor for postoperative liver failure[OR=8.979,95CI%(1.261,63.950),P=0.028]and pulmonary infection[OR=5.392,95CI%(1.102,26.39),P=0.038].It was not an independent risk factor for postoperative hemorrhage or bile leakage.Conclusion mFI-5 is an effective tool for predicting postoperative complications in elders undergoing LH.And mFI-5≥2 may be employed as an effective parameter.
作者
李勇坤
尤楠
王峥
吴柯
李靖
郑璐
Li Yongkun;You Nan;Wang Zheng;Wu Ke;Li Jing;Zheng Lu(Department of Hepatobiliary Surgery,Second Affiliated Hospital,Army Medical University,Chongqing 400037,China)
出处
《腹部外科》
2023年第1期12-16,共5页
Journal of Abdominal Surgery
基金
陆军军医大学教育改革研究课题(2021A10)
重庆市社会事业与民生保障科技创新专项(cstc2017shmsA00011)
重庆市自然科学基金面上项目(cstc2021jcyj-msxmX0991)。
关键词
肝细胞癌
腹腔镜肝切除术
衰弱指数
并发症
Hepatocellular carcinoma
Laparoscopic hepatectomy
Frailty index
Complication
