内脏型肥胖对腹腔镜直肠癌手术系膜完整度的影响及评价指标分析  

Impact of visceral obesity on the quality of laparoscopic total mesorectal excision for rectal cancer

作　　者：张元川[1] 陈丙辰[2] 何度[3] 江丹[3] 李为昊 吴清彬[2] 王自强[1] 漆锐[4] 

机构地区：[1]四川大学华西医院胃肠外科中心,成都610041 [2]四川大学华西医院临床医学院 [3]四川大学华西医院病理科 [4]四川大学华西医院放射科

出　　处：《腹部外科》2014年第4期245-250,共6页Journal of Abdominal Surgery

基　　金：四川省科技基金（No.2012FZ0005）

摘　　要：目的分析不同内脏型肥胖评分对腹腔镜直肠癌全系膜切除术手术质量及手术相关指标的影响。方法收集2011年7月至2012年12月行腹腔镜直肠癌全系膜切除术的190例直肠癌患者的临床资料，分别使用体质量指数（BMI）≥25kg／m2、内脏脂肪面积（VFA）≥100cm2、内脏脂肪体表比≥85cm2／m2以及系膜脂肪比（MFR）≥0．44作为临界指标将患者进行分类，评价不同评分对直肠癌手术质量的影响。结果以通用的Quirke直肠系膜完整度评价标准评价时，系膜完整率达97．8％。以BMI进行分类，两组间在术中术后以及系膜完整度等指标方面差异无统计学意义（P≥0．05）；以VFA进行分类，两组间在手术时间、切口长度、出血量、淋巴结检出率、系膜完整度方面差异有统计学意义（P〈0．05）；以内脏脂肪体表比（VFA／BSA）进行分类，两组间在切口长度及系膜完整度方面差异有统计学意义（P〈0．05）；以MFR比≥0．44为临界值进行分类时，两组间在系膜完整度、手术时间、切口长度及术后住院天数方面差异有统计学意义（P〈0．05）。经Logistic回归分析，仅VFA水平是反映直肠系膜完整度的危险因素。结论即使对于肥胖患者腹腔镜手术能达到满意的系膜完整切除，BMI并不能反映肥胖对腹腔镜直肠癌手术质量及手术难度的影响。采用更严格系膜完整度评价标准时，VFA作为评价内脏型肥胖的重要指标，较VFA／BSA、MFR及BMI能更敏感地反映肥胖对直肠癌术后系膜完整度以及手术难度的影响。Objective To evaluate the impact of visceral obesity score on the quality and outcome of laparoscopic total mesorectal excision. Methods From July 2011 to December 2012, a total of 190 patients diagnosed with rectal cancer undergoing laparoscopic total mesorectal excision were enrolled. Body mass index （BMI） 325 kg/m2, visceral fat area （VFA） ≥100 cm2, VFA/body surface area （VFA/BSA） 385 cm2/m2 and mesorectum fat ratio （MFR） ≥0. 44 were used to define obesity or visceral obesity. Results According to the Quirke Standard, 97. 8% surgical specimens achieved complete mesorectum excision. In BMI groups, no significant inter-group differences existed in quality and outcome （P≥0. 05）. In VFA groups, operative duration, incision length, blood loss, lymph node harvest and mesangial integrity were significantly different between two groups （P〈0. 05）. In VFA/ BSA groups, incision length and mesangial integrity were significantly different between two groups （P〈0. 05）. In mesorectum fat ratio groups, operative duration, incision length and postoperative hospital stay were significantly different between two groups （P〈0. 05）. After Logistic regression a- nalysis, only obesity defined with VFA was a risk factor of incomplete mesorectum excision. Conclu sions BMI can not reflect the impact of visceral fat on the quality and outcome of laparoscopic total mesorectal excision while VFA is a better index of reflecting the impact of visceral obesity over VFA/ BSA, MFR and BMI.

关 键 词：腹部肥胖症 直肠肿瘤 腹腔镜 

分 类 号：R735.37[医药卫生—肿瘤]