Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy.
Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy.
复制标题
术后血糖控制和营养状况对全胰腺切除术后临床结局的影响
DOI：
10.3748/wjg.v23.i2.265
复制
发表时间：
2017-01-14
影响因子：
4.3
通讯作者：
Fu DL
中科院分区：
文献类型：
--
作者：
Shi HJ;Jin C;Fu DL
评价全胰切除术（TP）后血糖控制和营养状况对并发症、肿瘤复发和总生存率的影响。从2007年至2015年收集了52例接受TP的胰腺肿瘤患者的回顾性记录。对术前、术后和随访期间收集的一系列临床参数进行评价。血糖控制和营养状况与并发症，肿瘤复发和长期生存的关系被确定。确定了术后血糖控制和营养状况的危险因素。术后早期空腹血糖（FBG）水平高（OR = 4.074，95%CI：1.188-13.965，P = 0.025）和术后早期前白蛋白水平低（OR = 3.816，95%CI：1.110-13.122，P = 0.034）与TP术后并发症显著相关。术后HbA 1c水平超过7%（HR = 2.655，95%CI：1.299-5.425，P = 0.007）被确定为肿瘤复发的独立危险因素之一。术后HbA 1c水平超过7%的患者的总生存率比HbA 1c水平低于7%的患者低得多（9.3个月vs 27.6个月，HR = 3.212，95%CI：1.147-8.999，P = 0.026）。长期糖尿病（HR = 15.019，95%CI：1.278-176.211，P = 0.031）和饮酒史（B = 1.985，SE = 0.860，P = 0.025）患者TP后血糖控制较差，体重指数水平较低。TP后至少需要3个月才能适应糖尿病并恢复营养状态。血糖控制似乎对TP后营养状况的长期结局有更大的影响。TP后血糖控制和营养状况的改善对预防早期并发症和肿瘤复发以及提高生存率非常重要。
To evaluate the impact of glycemic control and nutritional status after total pancreatectomy (TP) on complications, tumor recurrence and overall survival. Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified. High early postoperative fasting blood glucose (FBG) levels (OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels (OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative HbA1c levels over 7% (HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus (HR = 15.019, 95%CI: 1.278-176.211, P = 0.031) and alcohol history (B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively. At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.