肝胆管结石病患者肝切除术前体质量指数与术后严重并发症的关系

Relationship between preoperative body mass index and severe postoperative complications in patients with hepatolithiasis undergoing liver resection

摘要:

背景与目的 体质量指数（BMI）作为一项重要的营养和健康指标，与术后并发症的发生有着密切联系。本研究探讨肝胆管结石病患者肝切除术前BMI与发生严重并发症的关系，旨在为临床医生提供术前指导，降低术后并发症发生风险，确保手术安全和效果。方法 回顾性收集2006年5月—2022年12月中国人民解放军陆军军医大学第一附属医院和北京清华长庚医院收治的484例接受肝切除术的肝胆管结石病患者的临床资料。根据术前BMI将患者分为低BMI组（≤18.4 kg/m²）、正常BMI组（18.5~24.9 kg/m²）和高BMI组（≥25.0 kg/m²），比较正常BMI组与低BMI组、高BMI组患者的基线特征、手术总并发症和严重并发症发生情况及其他术后结局指标，并分析肝胆管结石患者肝切除术后严重并发症发生的危险因素。结果 484例患者中，低BMI组79例（16.3%），正常BMI组328例（67.8%），高BMI组77例（15.9%）。高BMI组的美国麻醉医师协会评分、术前白蛋白水平和高血压比例均明显高于正常BMI组（均P<0.05）；低BMI组的基线资料与正常BMI组差异无统计学意义（均P>0.05）。三组间总并发症发生率差异无统计学意义（P>0.05）；高BMI组的严重并发症（Clavien-Dindo并发症分级Ⅲ~Ⅳ级）、术后感染、肝功能衰竭和胆汁漏发生率明显高于正常BMI组（均P<0.05）；低BMI组的围手术期输血、术后感染、肝功能衰竭和二次手术发生率明显高于正常BMI组（均P<0.05）。单因素与多因素Logistic回归模型显示，高BMI以及术前总胆红素≥54 μmol/L是肝胆管结石病肝切除术后严重并发症发生的独立危险因素（均P<0.05）。结论 术前BMI与胆管结石病患者肝切除术后并发症发生密切相关，其中高BMI是严重并发症的独立危险因素；为控制严重并发症发生的风险，在临床实践中要重点关注伴有高BMI以及其他危险因素的人群。

Abstract:

Background and Aims Body mass index (BMI), an important indicator of nutrition and health, is closely associated with postoperative complications. This study was performed to investigate the relationship between preoperative BMI and severe complications in patients undergoing liver resection for hepatolithiasis, aiming to provide preoperative guidance for clinicians, reduce the risk of postoperative complications, and ensure surgical safety and efficacy.Methods The clinical data of 484 patients with hepatolithiasis who underwent liver resection between May 2006 and December 2022 at the First Affiliated Hospital of Army Medical University and Beijing Tsinghua Changgung Hospital were retrospectively collected. Patients were classified into low BMI group (≤18.4 kg/m2), normal BMI group (18.5-24.9 kg/m2), and high BMI group (≥25.0 kg/m2) based on preoperative BMI. Baseline characteristics, overall complications, severe complications, and other postoperative outcomes were compared between the normal BMI group and the low group as well as the high BMI group. Risk factors for severe complications after liver resection were analyzed.Results Among the 484 patients, 79 (16.3%) were in the low BMI group, 328 (67.8%) in the normal BMI group, and 77 (15.9%) in the high BMI group. The high BMI group had significantly higher ASA score, preoperative albumin level, and proportion of hypertension compared to the normal BMI group (all P<0.05). Baseline characteristics in the low BMI group showed no significant differences compared to the normal BMI group (all P>0.05). The incidence rates of overall complications were not significantly among the three groups (P>0.05). However, the high BMI group had significantly higher incidence rates of severe complications (Clavien-Dindo grade Ⅲ-Ⅳ), postoperative infections, liver failure, and bile leakage compared to the normal BMI group; the low BMI group had significantly higher rates of perioperative blood transfusion, postoperative infections, liver failure, and reoperation compared to the normal BMI group (all P<0.05). Univariate and multivariate Logistic regression analyses identified high BMI and preoperative total bilirubin ≥54 μmol/L as independent risk factors for severe complications after liver resection in patients with hepatolithiasis (both P<0.05).Conclusion Preoperative BMI is closely associated with the occurrence of complications after liver resection in patients with hepatolithiasis, with high BMI being an independent risk factor for severe complications. To mitigate the risk of severe complications, clinical practice should prioritize monitoring and management of individuals with high BMI and other risk factors