肥胖对男性直肠癌腹腔镜低位前切除手术的影响  

Effect of Obesity on Laparoscopic Low Anterior Resection for Rectal Cancer in Males

作　　者：沈荐[1] 熊天宇 李江媛 李敏哲[1] 谢德红[1] 杜燕夫[1] Shen Jian;Xiong Tianyu;Li Jiangyuan(Department of General Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China)

机构地区：[1]首都医科大学附属北京朝阳医院普外科,北京100020 [2]首都医科大学,北京100069

出　　处：《中国微创外科杂志》2020年第5期413-416,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨肥胖对男性直肠癌腹腔镜低位前切除术(laparoscopic low anterior resection,Lap-LAR)的影响。方法回顾性分析2014年3月~2017年8月91例男性直肠癌Lap-LAR的临床资料,以BMI≥28作为肥胖标准,肥胖组29例,非肥胖组62例。比较2组围手术期指标、术后病理指标和术后生存情况。结果2组Lap-LAR均顺利完成,均无中转开腹。对比非肥胖组,肥胖组手术时间较长[(149.0±27.2)min vs.(120.6±23.8)min,t=5.053,P=0.000],术中失血较多[(155.2±54.0)ml vs.(116.1±54.1)ml,t=3.177,P=0.002],术后排气较晚[(3.0±0.8)d vs.(2.4±1.0)d,t=3.113,P=0.003],术后住院时间较长[(9.7±4.5)d vs.(7.8±2.8)d,t=2.129,P=0.040],2组术后并发症发生率、病理完全缓解率、淋巴结检出数、淋巴结转移率、淋巴结转移数、肿瘤TNM分期差异均无显著性(P>0.05)。肥胖组术后随访8~59个月(中位数39.0月),非肥胖组术后随访9~60个月(中位数39.5月),2组累积生存率差异无显著性(log-rankχ^2=0.495,P=0.482)。结论肥胖的男性患者由于过多的脂肪填充,会增加Lap-LAR操作的难度。较之非肥胖患者,肥胖者术后恢复较慢,但术后生存情况无明显差异。Objective To analyze the effect of obesity on laparoscopic low anterior resection(Lap-LAR)of rectal cancer in males.Methods The clinical data of 91 male patients undergoing Lap-LAR in our department from March 2014 to August 2017 were retrospectively analyzed.Among them,29 cases were in the obese group(BMI≥28),and 62 cases were in the non-obese group(BMI<28).The peri-operative indicators,postoperative pathological indicators and postoperative survival were compared between the two groups.Results All the operations of Lap-LAR were successfully completed in both groups,without conversion to laparotomy.The operation time[(149.0±27.2)min vs.(120.6±23.8)min,t=5.053,P=0.000],the amount of bleeding during the operation[(155.2±54.0)ml vs.(116.1±54.1)ml,t=3.177,P=0.002],the intestinal exhaust time[(3.0±0.8)d vs.(2.4±1.0)d,t=3.113,P=0.003],and the postoperative hospital stay[(9.7±4.5)d vs.(7.8±2.8)d,t=2.129,P=0.040]in the obese group were more than those in the non-obese group.There were no significant differences in postoperative complication rate,pathologic complete response rate,number of total lymph nodes,lymph node metastasis rate,positive lymph nodes,and tumor stages between the two groups(P>0.05).The patients in the obesity group were followed up for 8-59 months(median,39.0 months),while those in the non-obesity group were followed up for 9-60 months(median,39.5 months).The survival curve had no significant difference between the two groups(log-rankχ^2=0.495,P=0.482).Conclusions Obesity increases the difficulty of Lap-LAR in males because of excessive fat,leading to slow recovery.There is no significant difference in the prognosis.

关 键 词：肥胖 男性 直肠癌 腹腔镜 预后 

分 类 号：R73[医药卫生—肿瘤]