体重指数对于肝癌患者肝切除术后预后的影响  

Impact of Body Mass Index on Prognosis after Hepatectomy for Patients with Hepatocellular Carcinoma

作　　者：毕华强[1] 刘辉[2] 张曦[2] 马宽生[2] 舒为群[1] 

机构地区：[1]第三军医大学军事预防医学院军队环境卫生学教研室,重庆400038 [2]第三军医大学第一附属医院肝胆外科,重庆400038

出　　处：《中国普外基础与临床杂志》2016年第11期1325-1330,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金重点项目(编号:81230064)~~

摘　　要：目的分析体重指数(BMI)对肝癌切除术后并发症及无瘤生存率的影响。方法采用回顾性队列研究方法,共纳入858例行手术切除的肝癌患者。将18.5 kg/m2<BMI<25.0 kg/m2者定义为体重正常组(602例),BMI≥25.0 kg/m2者定义为肥胖组(256例)。收集2组患者的临床资料及术后随访资料并进行统计分析。结果1与体重正常组相比,肥胖组患者术前HBV-DNA负荷量明显降低(P<0.05),血白蛋白水平明显升高(P<0.05),但术中出血量明显升高(P<0.05),手术时间和第一肝门阻断时间均明显延长(P<0.05),2组患者术后住院时间及并发症发生率比较差异无统计学意义(P>0.05)。2单因素分析结果显示,术前HBV-DNA负荷量≥1×104 U/m L、总胆红素>21μmol/L、白蛋白<35 g/L、Child-Pugh B级、术中出血量>500 m L及手术时间>240 min是影响肝癌术后并发症发生的危险因素(P<0.05);多因素分析结果显示,术前总胆红素>21μmol/L、白蛋白<35 g/L及手术时间>240 min是影响肝癌术后并发症发生的独立危险因素(P<0.05),而肥胖则不是影响术后并发症发生的因素。3 Kaplan-Meier分析结果显示,肥胖组患者术后的3年无瘤生存率高于体重正常组(P<0.05);多因素分析结果显示,大血管癌栓、多发肿瘤、肿瘤直径≥5 cm及手术时间>240 min是影响肝癌患者术后3年无瘤生存率的独立危险因素(P<0.05),而肥胖是3年无瘤生存率的独立保护因素(P<0.05)。结论对于行肝癌切除术的患者,肥胖不是术后并发症发生的危险因素,且肥胖患者的3年无瘤生存率明显高于体重正常者,因此,术前积极改善患者营养状况具有重要意义。Objective To analyze impact of body mass index （BMI） on postoperative complications and diseasefree survival （DFS） after hepatectomy for patients with hepatocellular carcinoma （HCC）. Methods In total, 858 patients with HCC underwent hepatectomy were analyzed by retrospective cohort study. Patients were divided into two groups according to BMI： normal group （18.5 kg/m^2〈BMI〈25.0 kg/m^2） and obesity group （BMI ≥25.0 kg/m^2）. The clinical and postoperative follow-up data were collected and statistically analyzed. Results （1） Compared with the normal group, the preoperative HBV-DNA loading was significantly lower （P〈0.05）, albumin was significantly higher （P〈O.05）, intraoperatire blood loss was significantly increased （P〈0.05）, operation time, and the first portal hepatis occlusion time were significantly prolonged （P〈0.05） in the obesity group. The postoperative complications and hospital stay had no significant differences between these two groups （P〉0.05）. （2） The results of univariate analysis showed that the preoperative HBV- DNA t〉 104 U/mL, total bflirubin 〉21 μmol/L, albumin 〈35 g/L, grade B of Child-Pugh, intraoperative blood loss 〉500 mL, and operation time 〉240 rain were associated with the postoperative complications after hepatectomy for patients with HCC （P〈0.05）. The results of multivariate analysis showed that preoperative total bilirubin 〉21 μmol/L, albumin 〈35 g/L, and operation time 〉240 min were the independent risk factors for postoperative complications （P〈0.05）. （3） Kaplan-Meier analysis showed that the 3-year DFS in the obesity group was significantly better than that in the normal group （P〈0.05）.The results of multivariate analysis showed that the major blood vessel tumor thrombi, multicenter tumor, tumor diameter ≥5 cm, and operation time 〉240 min were the independent risk factors for DFS （P〈0.05）, while the obesity was the protective factor for DFS （P〈0.05）. Conclusions

关 键 词：肝癌 体重指数 肥胖 并发症 无瘤生存率 

分 类 号：R735.7[医药卫生—肿瘤]