体型对腹腔镜远端胃癌根治术后近期疗效的多中心回顾性研究(附506例报告)  

Influence of body shape on the short-term therapeutic effects of laparoscopic distal gastrectomy:a multicentre retrospective study (A report of 506cases)

作　　者：林和新 燕速[2] 叶志坚[3] 张健 蔡丽生 陈锦萍[6] 苏国强[7] 张国伟 傅锦波[3] 卢传辉[7] 王亮 纪伟平 孔文成 龚江 陈平 黄荣杰 柯海林 沈贤[9] 尤俊[7] Lin Hexir;Yan Su;Ye Zhijian;Zhang Jian;Cai Lisheng;Chen Jinping;Su Guoqiang;Zhang Guowe;Fu Jinbo;Lu Chuanhui;Wang Liang;Ji Weiping;Kong Wencheng;Gong Jiang;Chert Ping;Huang Rongjie;Ke Hailin;Shen Xian;You Jun(School of Clinical Medicine of Fujian Medical University,Fuzhou 350122,China;Department of Gastrointestinal Oncology Surgery,the Affiliated Hospital of Qinghai University,Xi'ning 810001,China;Department of General Surgery and Gastrointestinal Surgery,Zhongshan Hospital,Xiamen University,Xiamen 361003,China;Department of Gastrointestinal Surgery,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Fourth Department of General Surgery,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou 363000,China;Department of General Surgery,Affiliated Quanzhou First Hospital,Fujian Medical University,Quanzhou 362002,China;Department of Gastrointestinal Oncology Surgery, Xiamen Cancer Hospital,the First Affiliated Hospital of Xiamen University,Teaching Hospital of Fujian Medical University,Xiamen 361003,China;Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Xiamen Medical College,Xiamen 361022,China;Department of Gastrointestinal Surgery,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]福建医科大学临床医学部,福州350122 [2]青海大学附属医院胃肠肿瘤外科,西宁810001 [3]厦门大学附属中山医院普通外科、胃肠外科,361003 [4]浙江大学医学院附属杭州市第一人民医院胃肠外科,310006 [5]福建医科大学附属漳州市医院普通外四科,363000 [6]福建医科大学附属泉州市第一医院普通外科,362002 [7]厦门大学附属第一医院厦门市肿瘤医院福建医科大学教学医院胃肠肿瘤外科,361003 [8]厦门医学院附属第二医院胃肠外科,361022 [9]温州医科大学附属第二医院胃结肠外科,325027

出　　处：《中华消化外科杂志》2019年第1期65-73,共9页Chinese Journal of Digestive Surgery

基　　金：青海省科学技术厅资助项目(2018一SF一113);吴阶平医学基金会临床科研专项(320.6750.17509);杭州市科委基金项目(20171226Y11).

摘　　要：目的探讨影响腹腔镜远端胃癌根治术围术期并发症的危险因素,以及体型对该手术方式近期疗效的影响。方法采用回顾性病例对照研究方法。收集2016年3月至2018年11月国内8家医疗中心收治的506例(厦门大学附属第一医院143例,青海大学附属医院66例,温州医科大学附属第二医院66例,厦门大学附属中山医院64例,浙江大学医学院附属杭州市第一人民医院54例,福建医科大学附属漳州市医院48例,福建医科大学附属泉州第一医院35例,厦门医学院附属第二医院30例)行腹腔镜远端胃癌根治与D2淋巴结清扫术患者的临床病理资料;男328例,女178例;平均年龄为60岁,年龄范围为24~85岁。患者术前影像学检查指标:脐水平最大腹壁厚度(USCF)、经脐部腹腔最大前后径(UAPD)、经脐部腹腔最大左右径(UTD)、经剑突最高点腹腔最大前后径(XAPD)、经剑突最高点腹腔最大左右径(XTD)、腹壁至腹腔动脉根部腹腔最大前后径(CAD)、经腹腔动脉根部腹腔左右径(CATD)。观察指标:(1)术中和术后情况。(2)随访情况。(3)影响围术期并发症发生的危险因素分析。(4)体型相关各项指标对术中情况和术后恢复的影响:①Pearson单因素相关性分析。②线性回归模型分析。采用门诊和电话方式进行随访,了解患者术后生存情况、肿瘤复发转移情况。随访时间截至2018年12月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(范围)表示。计数资料比较采用χ2检验,等级资料比较采用Mann-WhitneyU非参数检验。采用Logistic回归分析影响腹腔镜远端胃癌手术围术期并发症发生的危险因素。采用Pearson单因素相关性分析,采用线性回归模型评估各体型因素对术中情况及术后恢复的影响。结果(1)术中和术后情况:506例患者均顺利完成腹腔镜远端胃癌根治术,消化道重建:BillrothⅠ式吻合103例,BillrothⅡ式吻合140例,BillrothⅡ+BraunObjectiveTo investigate the risk factors of perioperative complications of laparoscopic radical distal gastrectomy and influence of body shape on the short-term therapeutic effects. MethodsThe retrospective case-control study was conducted. The clinicopathological data of 506 patients (328 males and 178 females, average age 60 years with the range of 24-85 years) who underwent laparoscopic radical distal gastrectomy+D2 lymph nodes dissection in the 8 clinical centers between March 2016 and November 2018 were collected, including 143 in the First Affiliated Hospital of Xiamen University, 66 in the Affiliated Hospital of Qinghai University, 66 in the Second Affiliated Hospital of Wenzhou Medical University, 64 in the Zhongshan Hospital of Xiamen University, 54 in the Affiliated Hangzhou First people′s Hospital of Zhejiang University School of Medicine, 48 in the Zhangzhou Affiliated Hospital of Fujian Medical University, 35 in the Affiliated Quanzhou First Hospital of Fujian Medical University, 30 in the Second Affiliated Hospital of Xiamen Medical College. The maximum thickness of subcutaneous fat at the level of umbilicus (USCF), the maximum vertical distance between the anterior abdominal skin and the back skin at the level of the umbilicus (UAPD), the maximum horizontal distance between the anterior abdominal skin and the back skin at the level of the umbilicus (UTD), the maximum vertical distance between the anterior abdominal skin and the back skin at the level of the xiphoid bone (XAPD), the maximum horizontal distance between the anterior abdominal skin and the back skin at the level of the xiphoid bone (XTD), the distance between the anterior abdominal skin and the root of celiac artery (CAD) and the maximum horizontal distance at a right angle to CAD (CATD) were measured using preoperative imaging examinations. Observation indicators: (1) intraoperative and postoperative situations;(2) follow-up situations;(3) risk factors analysis of perioperative complications;(4) influence of body shape related index

关 键 词：胃肿瘤 胃癌 根治胜切除术 腹腔镜检查 体型 回顾性研究 

分 类 号：R735.2[医药卫生—肿瘤]