体质量指数对直肠癌腹腔镜全直肠系膜切除术患者的影响  

Effect of body mass index on patients with rectal cancer undergoing laparoscopic total mesorectal excision

作　　者：李培哲[1] 吕绪昆 高恒岭[1] 黑颖睿[1] 刘西山[1] Li Peizhe;Lyu Xukun;Gao Hengling;Hei Yingrui;Liu Xishan(Department of Gastrointestinal Surgery,the Second People's Hospital of Liaocheng,Shandong Linqing 252600,China)

机构地区：[1]山东省聊城市第二人民医院胃肠外科,山东临清252600

出　　处：《中国医师进修杂志》2019年第1期6-9,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的研究不同体质量指数(BMI)对直肠癌腹腔镜全直肠系膜切除术(TME)患者的手术安全性及近期临床结局的影响。方法回顾性分析2016年11月至2017年11月179例行腹腔镜TME的直肠癌患者的临床资料,根据BMI将患者分为三组:偏瘦组(BMI<18.5kg/m2,15例)、正常组(BMI18.5~22.9kg/m2,89例)、超重肥胖组(BMI≥23.0kg/m2,75例)。比较三组患者的一般临床资料及手术相关情况。结果超重肥胖组术前合并症多于偏瘦组和正常组[45.33%(34/75)比4/15和28.09%(25/89)],偏瘦组术前白蛋白低于正常组和超重肥胖组[(36.3±2.8)g/L比(38.6±3.2)和(39.1±3.7)g/L],差异均有统计学意义(P<0.05)。超重肥胖组手术时间和术中出血量明显大于偏瘦组和正常组[(149.2±32.9)min比(129.3±28.7)、(133.5±23.6)min和(135.5±29.0)ml比(117.5±22.6)、(122.5±25.9)ml],差异有统计学意义(P<0.05)。三组性别构成、年龄、肿瘤位置、肿瘤最大直径、肿瘤浸润深度、淋巴结转移、手术方式、环周切缘、淋巴结清扫数、切除长度、术后并发症、手术部位感染、术后尿潴留、术后排气时间及术后住院时间比较差异均无统计学意义(P>0.05)。结论BMI的不同意味着患者合并症及营养状况的不同,超重和肥胖会导致直肠癌患者行腹腔镜TME时操作困难,但不影响手术的根治性及患者的近期临床结局。ObjectiveTo study the safety and short-term clinical outcome of different body mass index (BMI) patients with rectal cancer undergoing laparoscopic total mesorectal excision (TME).MethodsThe clinical data of 179 rectal cancer patients who had underwent laparoscopic TME from November 2016 to November 2017 were retrospectively analyzed. The patients were divided into 3 groups according to the BMI: leanness group (BMI<18.5 kg/m2, 15 cases), normal group (BMI 18.5 to 22.9 kg/m2, 89 cases) and overweight/obesity group (BMI ≥ 23.0 kg/m2, 75 cases). The general clinical data and the operation-related situation were compared.ResultsThe rate of preoperative complications in overweight/obesity group was significantly higher than that in leanness group and normal group: 45.33% (34/75) vs. 4/15 and 28.09% (25/89), the preoperative albumin level in leanness group was significantly lower than that in normal group and overweight/obesity group: (36.3 ± 2.8) g/L vs. (38.6 ± 3.2) and (39.1 ± 3.7) g/L, and there were statistical differences (P<0.05). The operation time and blood loss in overweight/obesity group were significantly higher than those in leanness group and normal group: (149.2 ± 32.9) min vs. (129.3 ± 28.7) and (133.5 ± 23.6) min, (135.5 ± 29.0) ml vs. (117.5 ± 22.6) and (122.5 ± 25.9) ml, and there were statistical differences (P<0.05). There were no statistical differences in sex, age, tumor location, tumor maximum diameter, depth of tumor invasion, lymph node metastases, surgical approach, circumferential margin, number of lymph node dissections, length of resected specimens, incidence of postoperative complications, surgical site infection, postoperative urinary retention, postoperative exhaust time and postoperative hospitalization among 3 groups (P>0.05).ConclusionsThe differences of BMI mean different complications and nutritional status of patients. Overweight and obesity can lead to difficult operation of laparoscopic TME, but do not affect the radical cure of operations and the safety of clinical o

关 键 词：直肠肿瘤 人体质量指数 腹腔镜 全直肠系膜切除术 

分 类 号：R735.37[医药卫生—肿瘤]