国际肿瘤学杂志

国际肿瘤学杂志 ›› 2026, Vol. 53 ›› Issue (2): 87-92.doi: 10.3760/cma.j.cn371439-20250607-00013

• 论著 • 上一篇    下一篇

胃癌根治术后患者营养状况与术前胃形态和功能特征的相关性分析

阿里亚·艾海提1, 努力满·赛麦特2, 王婷婷1()   

  1. 1新疆医科大学第一附属医院胃肠（肿瘤）外科，乌鲁木齐 830054
    2新疆医科大学第一附属医院急救·创伤中心，乌鲁木齐 830054
  • 收稿日期:2025-06-07 出版日期:2026-02-08 发布日期:2026-01-29
  • 通讯作者: 王婷婷，Email：smile202022@163.com
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2021D01C328)

Analysis of the correlation between nutritional status and preoperative gastric morphology and functional characteristics in patients with gastric cancer after radical gastrectomy

Arya Ehmet1, Nuriman Samat2, Wang Tingting1()   

  1. 1Department of Gastrointestinal （Tumor） Surgery， First Affiliated Hospital of Xinjiang Medical University， Urumqi 830054， China
    2First Aid Trauma Center， First Affiliated Hospital of Xinjiang Medical University， Urumqi 830054， China
  • Received:2025-06-07 Online:2026-02-08 Published:2026-01-29
  • Contact: Wang Tingting， Email：smile202022@163.com
  • Supported by:
    Natural Science Foundation of Xinjiang Uygur Autonomous Region of China(2021D01C328)

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摘要：

目的 探讨胃癌根治术后患者营养状况与术前胃形态和功能特征的相关性。方法 选择2021年9月至2024年9月于新疆医科大学第一附属医院行胃癌根治术（远端胃大部切除）的134例Ⅰ~Ⅱ期胃癌患者作为研究对象。收集患者临床资料（包括胃形态和功能特征），按照手术前胃形态分为流出组（n=51）和留存组（n=83）。于术前1周及术后1个月收集患者人体成分分析相关指标。采用多元线性回归分析营养学指标的相关影响因素。统计并比较两组患者术后7 d内倾倒综合征、腹泻、胃食管反流的发生情况，并比较不同并发症患者的营养学指标下降情况。结果 流出组、留存组患者术前1周的体质量指数（BMI）分别为（21.29±1.21）、（21.09±1.36）kg/m2，去脂BMI分别为（15.29±1.07）、（15.31±1.08）kg/m2，脂肪指数分别为（5.98±0.92）、（5.84±0.83）kg/m2，骨骼肌指数分别为（10.13±1.02）、（10.23±1.98）kg/m2，无机盐指数分别为（5.01±0.98）、（4.94±0.81）kg/m2，差异均无统计学意义（均P>0.05）；两组患者术后1个月的BMI分别为（20.75±1.82）、（20.25±1.24）kg/m2，去脂BMI分别为（14.68±0.94）、（14.36±0.88）kg/m2，脂肪指数分别为（5.77±0.93）、（5.58±0.72）kg/m2，骨骼肌指数分别为（9.51±1.12）、（9.46±1.57）kg/m2，无机盐指数分别为（5.00±0.89）、（4.99±0.73）kg/m2，差异均无统计学意义（均P>0.05）；流出组患者术前1周的去脂BMI、骨骼肌指数均高于术后1个月（均P<0.05）；留存组患者术前1周的BMI、去脂BMI、脂肪指数及骨骼肌指数均高于术后1个月（均P<0.05）；两组患者术后1个月的BMI下降率分别为（3.62±0.49）%、（3.94±0.48）%，差异有统计学意义（t=3.67，P<0.001）；去脂BMI下降率分别为（3.75±0.51）%、（4.06±0.47）%，差异有统计学意义（t=3.52，P<0.001）；脂肪指数下降率分别为（3.54±0.43）%、（3.82±0.49）%，差异有统计学意义（t=3.47，P<0.001）；骨骼肌指数下降率分别为（3.76±0.53）%、（4.01±0.48）%，差异有统计学意义（t=2.75，P=0.007）；无机盐指数下降率分别为（0.14±0.05）%、（0.13±0.04）%，差异无统计学意义（t=1.21，P=0.229）。营养学指标的相关影响因素分析结果显示，胃形态学分类与脂肪指数下降率（t=-2.90，P=0.005）及骨骼肌指数下降率（t=-4.50，P<0.001）均独立相关，血清白蛋白（t=2.01，P=0.047）与骨骼肌指数下降率独立相关。术后7 d内，留存组患者并发症总发生率为36.14%（30/83），流出组为15.69%（8/51），差异有统计学意义（χ2=6.51，P=0.011）。发生倾倒综合征患者的脂肪指数下降率及骨骼肌指数下降率分别为（4.21±0.79）%、（4.48±0.94）%，未发生患者为（3.61±0.47）%、（3.84±0.43）%，差异均有统计学意义（t=2.59，P=0.025；t=2.33，P=0.039）；发生腹泻患者的脂肪指数下降率及骨骼肌指数下降率分别为（4.24±0.81）%、（4.41±0.85）%，未发生患者为（3.62±0.43）%、（3.85±0.41）%，差异均有统计学意义（t=2.62，P=0.024；t=2.26，P=0.045）；发生胃食管反流患者的脂肪指数下降率及骨骼肌指数下降率分别为（4.19±0.72）%、（4.45±0.89）%，未发生患者为（3.64±0.39）%、（3.82±0.43）%，差异均有统计学意义（t=2.61，P=0.024；t=2.42，P=0.037）。结论 术前胃形态功能学特征对于胃癌患者远端胃大部切除术后营养状态具有显著影响，与术后7 d内倾倒综合征、腹泻、胃食管反流等并发症的发生密切相关。

关键词: 胃肿瘤, 营养状况, 远端胃大部切除术, 术前胃型

Abstract:

Objective To explore the correlation between the nutritional status of patients and preoperative gastric morphology and functional characteristics in patients with gastric cancer after radical gastrectomy. Methods From September 2021 to September 2024， 134 patients with stage Ⅰ-Ⅱ gastric cancer who underwent radical gastrectomy （distal subtotal gastrectomy） at the First Affiliated Hospital of Xinjiang Medical University were selected as the research subjects. Clinical data of patients （including gastric morphology and functional characteristics） were collected and patients were divided into the outflow group （n=51） and the retention group （n=83） based on the preoperative gastric morphology. The related indicators of body composition analysis were collected one week before the surgery and one month after the surgery. Multiple linear regression analysis was used to analyze the related influencing factors of nutritional indicators. The occurrence of dumping syndrome， diarrhea and gastroesophageal reflux within 7 days after the surgery was statistically analyzed and compared between the two groups. The decline of nutritional indicators in patients with different complications was also compared. Results One week before surgery， the body mass index （BMI） values of patients in the outflow group and the retention group were （21.29±1.21） and （21.09±1.36） kg/m2， the fat-free BMI values were （15.29±1.07） and （15.31±1.08） kg/m2 ， the fat indexes were （5.98±0.92） and （5.84±0.83） kg/m2， the skeletal muscle indexes were （10.13±1.02） and （10.23±1.98） kg/m2， and the inorganic salt indexes were （5.01±0.98） and （4.94±0.81） kg/m2， with no statistically significant differences （all P>0.05）. One month after surgery， the BMI values of patients in the two groups were （20.75±1.82） and （20.25±1.24） kg/m2， the fat-free BMI values were （14.68±0.94） and （14.36±0.88） kg/m2 ，the fat indexes were （5.77±0.93） and （5.58±0.72） kg/m2， the skeletal muscle indexes were （9.51±1.12） and （9.46±1.57） kg/m2， and the inorganic salt indexes were （5.00±0.89） and （4.99±0.73） kg/m2， with no statistically significant differences （all P>0.05）. The fat-free BMI value and skeletal muscle index of the patients in the outflow group one week before the surgery were both higher than those one month after the surgery （both P<0.05）. The BMI value， fat-free BMI value， fat index and skeletal muscle index of the patients in the retention group one week before the surgery were all higher than those one month after the surgery （all P<0.05）. The BMI decrease rates of the two groups of patients one month after the surgery were （3.62±0.49）% and （3.94±0.48）%， respectively， with a statistically significant difference （t=3.67， P<0.001）. The decrease rates of fat-free BMI were （3.75±0.51）% and （4.06±0.47）%， respectively， with a statistically significant difference （t=3.52， P<0.001）. The rates of decrease in fat index were （3.54±0.43）% and （3.82±0.49）%， respectively， with a statistically significant difference （t=3.47， P<0.001）. The decrease rates of skeletal muscle index were （3.76±0.53）% and （4.01±0.48）%， respectively， with a statistically significant difference （t=2.75， P=0.007）. The decrease rates of inorganic salt index were （0.14±0.05）% and （0.13±0.04）%， respectively， with no statistically significant difference （t=1.21， P=0.229）. The analysis results of the related influencing factors of nutritional indicators showed that， gastric morphological classification was independently correlated with the decrease rate of fat index （t=-2.90， P=0.005） and the decrease rate of skeletal muscle index （t=-4.50， P<0.001）， and serum albumin （t=2.01， P=0.047） was independently correlated with the decrease rate of skeletal muscle index. Within 7 days after the surgery， the total incidence of complications in the retention group was 36.14% （30/83）， and that in the outflow group was 15.69% （8/51）， with a statistically significant difference （χ2=6.51， P=0.011）. The rates of decrease in fat index and skeletal muscle index in patients with dumping syndrome were （4.21±0.79）% and （4.48±0.94）%， respectively， while those in patients without dumping syndrome were （3.61±0.47）% and （3.84±0.43）%， respectively， with statistically significant differences （t=2.59， P=0.025； t=2.33， P=0.039）. The rates of decrease in fat index and skeletal muscle index in patients with diarrhea were （4.24±0.81）% and （4.41±0.85）%， respectively， while those in patients without diarrhea were （3.62±0.43）% and （3.85±0.41）%， respectively， with statistically significant differences （t=2.62， P=0.024； t=2.26， P=0.045）. The rates of decrease in fat index and skeletal muscle index in patients with gastroesophageal reflux were （4.19±0.72）% and （4.45±0.89）%， respectively， while those in patients without gastroesophageal reflux were （3.64±0.39）% and （3.82±0.43）% ， respectively， with statistically significant differences （t=2.61， P=0.024； t=2.42， P=0.037）. Conclusions The preoperative gastric morphology and functional characteristics have a significant influence on the nutritional status of patients with gastric cancer after distal subtotal gastrectomy， and are also closely related to the occurrence of complications such as dumping syndrome， diarrhea and gastroesophageal reflux within 7 days after surgery.

Key words: Stomach neoplasms, Nutritional status, Distal gastrectomy, Preoperative gastric shape