肥胖对行全胃切除术的胃癌患者围手术期的影响  

Effect of Obesity on Perioperative Status in Patients with Total Gastrectomy for Gastric Cancer

作　　者：闫世贤[1] 佟伟华[2] 陈羽佳[2] 刘恒昌[2] 徐越超[2] 

机构地区：[1]山东省潍坊市中医院肿瘤外科,261041 [2]吉林大学白求恩第一医院胃结直肠外科

出　　处：《胃肠病学》2016年第7期409-413,共5页Chinese Journal of Gastroenterology

摘　　要：背景:目前主要采用体质指数(BMI)评估肥胖。但有研究发现,BMI相同者的脂肪分布不尽相同,内脏脂肪与皮下脂肪对疾病的影响也存在差异。目的:观察肥胖对行全胃切除术的胃癌患者围手术期的影响。方法:将294例行全胃切除术的胃癌患者根据BMI分为偏瘦组、正常组、偏胖组和肥胖组,根据内脏脂肪面积与总脂肪面积百分比(V/T)将患者分为内脏肥胖(VFv)组和皮下肥胖(VFs)组。分析各组患者的基本资料、手术与术后恢复情况以及BMI、V/T与总体生存率的关系。结果:偏瘦组和肥胖组术后并发症发生率显著高于正常组和偏胖组(P<0.05),偏瘦组以吻合口瘘和营养不良为主,肥胖组以切口脂肪液化和切口感染裂开为主。VFv组术后并发症发生率显著低于VFs组(P<0.05),两组术后并发症均以切口脂肪液化和吻合口瘘为主。正常组(60.8%)和偏胖组(57.4%)生存率显著高于肥胖组(39.2%)和偏瘦组(21.4%)(P<0.05),VFs组生存率显著高于VFv组(61.3%对48.8%,P<0.05)。多因素生存分析结果显示,城乡构成比、TNM分期、肿瘤分化程度、BMI值和V/T值是影响胃癌患者预后的因素(P<0.05)。结论:肥胖可能是行全胃切除术胃癌患者预后较差的标志。Background： Body mass index （BMI） is commonly used for the evaluation of obesity. Studies have shown that the distribution of fat may be different in people with same BMI, and effects of visceral fat and subcutaneous fat on the disease are also different. Aims： To study the effect of obesity on perioperative status in patients with total gastrectomy for gastric cancer. Methods： A total of 294 gastric cancer patients undertaking total gastrectomy were divided into slim group, normal group, overweight group and obese group according to BMI; and visceral obesity （VFv） group and subcutaneous obesity （VFs） group were categorized according to the percentage of visceral fat area to total fat area （V/T）. Basic data, surgery, postoperative recovery, and relationships between BMI, V/T and overall survival rate were analyzed. Results： The incidence of postoperative complication in slim group and obese group was significantly higher than that in normal group and overweight group （ P 〈 0.05 ）. Main postoperative complications were anastomotic fistula and malnutrition in slim group, and incision fat liquefaction and infection in obese group. The incidence of postoperative complication in VFv group was significantly lower than that in VFs group （ P 〈 0.05 ）. Main postoperative complications in VFv group and VFs group were incision fat liquefaction and anastomotie fistula. Overall survival rates in normal group （60.8%） and overweight group （57.4%） were significantly higher than those in obese group （39.2%） and slim group （21.4%） （P 〈0.05） ; survival rate in VFs group was significantly higher than that in VFv group （61.3% vs. 48.8%, P 〈 0.05 ）. Multivariate survival analysis showed that the urban/rural ratio, TNM staging, tumor differentiation, BMI value and V/T value were the prognostic factors of gastric cancer patients. Conclusions： Obesity may be a marker for poor prognosis of gastric cancer patients after total gastrectomy.

关 键 词：胃肿瘤 肥胖症 全胃切除术 围手术期 预后 

分 类 号：R735.2[医药卫生—肿瘤]