肥胖及超重患者行腹腔镜胃癌D_2根治术的安全性、近期效果及手术策略  

Safety,short-term outcome and surgical strategy of laparoscopic D_2 lymph nodes dissection of gastric cancer for overweight and obese patients

作　　者：黄海涛[1] 刘宏斌[1] 韩晓鹏[1] 朱万坤[1] 于建平[1] 王璟[1] 

机构地区：[1]兰州军区兰州总医院,甘肃兰州730050

出　　处：《腹腔镜外科杂志》2014年第7期485-489,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨肥胖及超重患者行腹腔镜胃癌根治术的安全性及近期效果,并针对肥胖及超重患者制定手术对策。方法:回顾性选取2012年6月至2013年8月接受腹腔镜胃癌根治术的患者,其中超重或肥胖组42例(BMI≥25 kg/m2),正常及低体重组174例(BMI<25 kg/m2),对比两组患者围手术期结果。结果:超重及肥胖组BMI平均(26.0±1.4)kg/m2,正常及低体重组平均(22.0±2.1)kg/m2,两组患者年龄、性别、糖尿病史、肿瘤类型、淋巴结清扫数量、淋巴结转移数量或淋巴结转移率、术后感染、术后并发症、术后恢复时间差异无统计学意义(P>0.05),手术时间、手术出血量差异有统计学意义(P<0.05)。结论:腹腔镜胃癌根治术应用于肥胖或超重患者虽然手术难度相应增加,在术者具备丰富腹腔镜手术经验、遵循根治原则的基础上,手术是安全、可行的。Objective：To investigate the safety and short-term outcome of laparoscopic D2 lymph nodes dissection of gastric cancer,in addition to set surgical decision for overweight and obese patients. Methods：Perioperative outcomes were compared between42 patients with a BMI exceeding 25 kg /m^2（overweight or obese group） and 174 patients with a BMI lower than 25 kg/m^2（normal or underweight group） who underwent laparoscopic radical resection of gastric cancer between Jun. 2012 and Aug. 2013. Results：The BMI was（26. 0 ± 1. 4） kg /m^2 in the overweight or obese group and（22. 0 ± 2. 1） kg /m^2 in the normal or underweight group. There were no significant differences between the two groups in terms of age,sex,presence of diabetes,tumor size,number of retrieved lymph nodes,number of metastatic lymph nodes,or metastatic lymph node ratio. And there were significant differences between the two groups in operation time [overweight or obese group：（212 ± 31） min vs. normal or underweight group：（200 ± 35） min;P = 0. 005] and bleeding volume [overweight or obese group（15 ± 22） ml vs. normal or underweight group（10 ± 34） ml,P = 0. 013]. Postoperative complications,infections and recovery after surgery did not differ between the two groups（ P 〉0. 05）. Conclusions：For overweight and obese patients,laparoscopic D2 lymph nodes dissection of gastric cancer is more difficult,but it is safe and feasible based on the rich experience in laparoscopic operation and the abidance by the radical principle.

关 键 词：胃肿瘤 胃癌根治术 腹腔镜检查 肥胖 安全性 手术后并发症 

分 类 号：R735.2[医药卫生—肿瘤]