中心型肥胖对腹腔镜远端胃癌D2根治术临床疗效的影响  

Effect of central obesity on clinical efficacy of laparoscopic D2 radical gastrectomy for distal gastric cancer

作　　者：沈荐[1] 李敏哲[1] 杜燕夫[1] SHEN Jian;LI Minzhe;DU Yanfu(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,100020

出　　处：《临床外科杂志》2022年第3期261-265,共5页Journal of Clinical Surgery

摘　　要：目的 评价中心型肥胖对腹腔镜远端胃癌D2根治术临床疗效的影响。方法 收集2013年4月~2021年1月间,于首都医科大学附属北京朝阳医院行腹腔镜远端胃癌D2根治手术的168例病人临床及病理资料。以男性腰围≥85 cm、女性腰围≥80 cm为中心型肥胖进行分组,肥胖组共64例,非肥胖组共104例。采用倾向性评分匹配法平衡两组病人除体重指数(BMI)及腰围之外的临床基线特征,比较匹配后两组手术相关指标、术后并发症指标、术后病理指标及预后指标。结果 匹配前肥胖组与非肥胖组基础资料(除BMI及腰围)比较,年龄和麻醉危险度评分差异有统计学意义(P<0.05)。1∶1匹配后,肥胖组与非肥胖组各有61例病例匹配成功,两组基础资料(除BMI及腰围)比较,差异无统计学意义(P>0.05)。两组手术相关指标比较,肥胖组手术时间为(219.8±33.6)分钟、术中出血量为(156.6±55.1)ml、术后住院时间为(14.6±2.3)天,非肥胖组分别为(198.2±24.7)分钟、(122.1±44.3)ml、(13.4±2.7)天,两组比较差异有统计学意义(P<0.05);肥胖组术后胃肠功能恢复时间为(3.0±0.8)天,非肥胖组为(2.8±0.9)天,差异无统计学意义(P>0.05)。两组术后并发症指标比较,肥胖组术后共有15例出现22例次并发症,非肥胖组术后共有13例出现18例次并发症,差异无统计学意义(P>0.05)。两组术后病理指标比较,肥胖组淋巴结清扫数为(21.9±4.2)枚、淋巴结转移率为77.0%、阳性淋巴结数为(3.3±2.4)枚、术后pTNM分期Ⅰ/Ⅱ/Ⅲ期为17/23/21,非肥胖组分别为(22.4±5.6)枚、70.5%、(3.1±2.4)枚、19/23/19,差异无统计学意义(P>0.05)。两组预后指标比较,肥胖组术后有16例因肿瘤复发及转移死亡,非肥胖组术后有14例因肿瘤复发及转移死亡,两组总体生存期差异无统计学意义(P>0.05)。结论 中心型肥胖增加了腹腔镜远端胃癌D2根治术的操作难度,中心型肥胖病人术后恢复更慢,但预后并不受影Objective To evaluate the effect of central obesity on the clinical efficacy of laparoscopic D2 radical gastrectomy for distal gastric cancer.Methods The clinical and pathological data of 168 patients with distal gastric cancer who underwent laparoscopic D2 radical gastrectomy in Beijing Chaoyang Hospital Affiliated to Capital Medical University from April 2013 to January 2021 were collected.The male waist circumference ≥85 cm and female waist circumference ≥80 cm were divided into two groups.There were 64 cases in obesity group and 104 cases in non-obesity group.Propensity score matching method was used to balance the clinical baseline characteristics of the two groups except BMI and waist circumference.The operation related indexes, postoperative complications indexes, postoperative pathological indexes and prognostic survival indexes were compared between the two groups after matching.Results Before matching, there were significant differences in age and anesthesia risk score between obese group and non-obese group(except BMI and waist circumference)(P<0.05).After matching, 61 cases in obesity group and 61 cases in non-obesity group were matched successfully.There was no significant difference in basic data(except BMI and waist circumference) between the two groups(P>0.05).The operation related indexes of the two groups were compared, the operation time, intraoperative blood loss and postoperative hospital stay were(219.8±33.6)min,(156.6±55.1) ml and(14.6±2.3) days in obese group and(198.2±24.7) min,(122.1±44.3) ml and(13.4±2.7) days in non-obese group, the difference was statistically significant(P<0.05).The recovery time of gastrointestinal function was(3.0±0.8) days in the obese group and(2.8±0.9) days in the non-obese group, the difference was not statistically significant(P>0.05).Comparison of postoperative complications between the two groups, there were 15 patients with 22 complications in the obese group and 13 patients with 18 complications in the non-obese group, the difference was not st

关 键 词：中心型肥胖 胃肿瘤 远端胃大部切除术 腹腔镜 预后 倾向性评分匹配法 

分 类 号：R735.2[医药卫生—肿瘤]