膵頭十二指腸切除術症例におけるControlling Nutritional Statusを用いた術前栄養状態と術後合併症に関する検討  [in Japanese] Preoperative nutritional assessment by CONUT (Controlling Nutritional Status) and postoperative complications after pancreatoduodenectomy  [in Japanese]

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Abstract

<p>【目的】膵頭十二指腸切除術における術前の栄養状態が、手術部位感染、膵液瘻、術後合併症の発生に関係するかを明らかにする。【対象及び方法】当科にて膵頭十二指腸切除術を施行した症例に対し、術前のControlling nutritional status(CONUT)法による栄養評価と、手術部位感染、膵液瘻、Clavien-Dindo分類による術後合併症との関係について解析を行った。【結果】栄養評価を行った374例中、正常栄養群は133例、軽度障害群は192例、中等度障害群は49例認めた。手術部位感染、膵液瘻、Clavien-Dindo分類による術後合併症の発生と、栄養障害の程度に直接的な有意な関係は認めなかった。膵硬度で層別化したところ、膵液瘻の少ない硬化膵においては、術後合併症は栄養障害群で有意に多く認めた(p=0.02)。また全症例から術後膵液瘻発生症例を除いた症例においても術後合併症は栄養障害群で多かった(p=0.02)。【結論】膵液瘻の影響が少ない症例において、術前の栄養障害は術後合併症の発生と関係した。術前の栄養評価および介入は、術後合併症を減らす可能性が示唆された。</p>

<p><b>Background:</b> CONUT (Controlling nutritional status) is a useful tool for preoperative nutritional evaluation. The relationship between the preoperative nutritional status and the postoperative complications of pancreatoduodenectomy has not yet been fully understood. The purpose of this study is to determine whether the preoperative nutritional status relates to the postoperative complications.</p><p><b>Methods:</b> Preoperative CONUT scores of total 374 patients before pancreatoduodenectomy were compared to the postoperative complications, including surgical site infection, postoperative pancreatic fistula, and general postoperative complications graded by Clavien-Dindo classification.</p><p><b>Results:</b> The preoperative nutritional status of 374 patients who underwent pancreatoduodenectomy was assessed by CONUT, 133 patients were judged as normal nutrition, 192 patients as mild malnutrition, and 49 patients as moderate malnutrition. No significant relation was observed between the preoperative nutritional status and the postoperative complications. Subgroup analysis with pancreatic texture revealed that postoperative complications by Clavien Dindo classification was significantly higher in the cases of malnutrition than normal in the population of the hard pancreas, where postoperative pancreatic fistula is rare (p=0.02). The postoperative complication was also high in the impaired nutrition group, when analyzed only in the cases without postoperative pancreatic fistula.</p><p><b>Conclusion:</b> This study showed that impaired preoperative nutrition related to postoperative complications in the cases without pancreatic fistula. Preoperative nutritional improvement might reduce the postoperative complications.</p>

Journal

  • Journal of Japanese Society for Parenteral and Enteral Nutrition

    Journal of Japanese Society for Parenteral and Enteral Nutrition 33(1), 641-646, 2018

    Japanese Society for Parenteral and Enteral Nutrition

Codes

  • NII Article ID (NAID)
    130006712529
  • NII NACSIS-CAT ID (NCID)
    AA12716548
  • Text Lang
    JPN
  • ISSN
    2189-0161
  • NDL Article ID
    029066458
  • NDL Call No.
    Z19-1877
  • Data Source
    NDL  J-STAGE 
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