腹部内脏脂肪面积对直肠癌手术预后评估价值的研究  

Study on the value of abdominal visceral fat area in evaluating the prognosis of patients after rectal cancer surgery

作　　者：师帅 吴云桦 马文星 胥博愈 陈昕 秦豪原 刘思达[1] 王泽正 张金 段降龙[1] Shi Shuai;Wu Yunhua;Ma Wenxing;Xu Boyu;Chen Xin;Qin Haoyuan;Liu Sida;Wang Zezheng;Zhang Jin;Duan Xianglong(Department of General Surgery,Shaanxi Provincial People’s Hospital,Xi’an 710068,China)

机构地区：[1]陕西省人民医院普外二科,西安710068

出　　处：《中华普通外科学文献（电子版）》2023年第1期34-39,共6页Chinese Archives of General Surgery(Electronic Edition)

基　　金：陕西省重点研发计划项目(2019ZDLSF02-09-01);陕西省科委基金项目(S2021-ZC-TD-0094);陕西省创新能力支撑计划项目(2019GHJD-14)。

摘　　要：目的探讨不同腹部内脏脂肪面积(VFA)的直肠癌患者围手术期恢复情况及近远期预后差异。方法回顾性分析2016年6月至2019年7月陕西省人民医院161例确诊为直肠癌且行手术治疗的患者资料。收集患者基础资料、病理资料、围手术期恢复指标以及术后随访状况,以CT值(HU)不同标记肌肉组织和脂肪组织,采用Slice-O-Matic软件得到第三腰椎层面VFA。以134.6 cm^(2)(男)和91.1 cm^(2)(女)为界值,对不同VFA组患者进行统计分析。结果与低VFA组相比,高VFA组患者手术时间延长[(253.05±70.09)min vs(227.16±93.10)min,t=1.506,P=0.048],术中出血量增加[(284.06±233.43)ml vs(192.84±323.57)ml,t=2.049,P=0.042],术中淋巴结清扫数量减少[(12.84±3.39)个vs(14.78±6.30)个,t=-2.439,P=0.016],术后禁饮食时间延长[(4.76±1.13)d vs(4.25±1.04)d,t=3.012,P=0.003],术后排气时间延长[(4.31±1.35)d vs(3.89±0.94)d,t=2.316,P=0.022],胃管留置时间增加[(3.05±2.06)d vs(2.46±1.18)d,t=2.235,P=0.027],术后住院时间增加[(14.56±6.09)d vs(12.72±5.55)d,t=2.011,P=0.046]。高VFA组患者术后总并发症发生率较低VFA组明显增加(27.5%vs 14.8%,χ^(2)=3.888,P<0.05),累积总生存率(62.4%vs 78.9%)和累积无病生存率(57.5%vs 75.9%)较低VFA组明显降低,差异均有统计学意义(P<0.05)。结论腹部VFA对直肠癌手术患者的预后评估具有一定价值,高VFA会增加直肠癌根治术难度,影响患者术后恢复和长期生存,增加患者围手术期并发症的发生风险。Objective To assess the perioperative recovery and short-and long-term postoperative outcomes of rectal cancer patients with different abdominal visceral fat area(VFA).Methods A total of161 patients with rectal cancer treated by surgery in Shaanxi Provincial People’s Hospital from June 2016to July 2019 were retrospectively analyzed.The clinical baseline data,perioperative recovery indicators,follow-up status of the patitents were collected,and the CT values(hounsfield unit,HU)were used to mark muscle tissue and adipose tissue differently.The VFA of the third lumbar vertebra bedding was obtained by Slice-O-Matic software.The patients were classified to high VFA group(≥134.6 cm^(2) in males and≥91.1 cm^(2) in females)and low VFA group(<134.6 cm^(2) in males and<91.1 cm^(2) in females).Results Compared with the low VFA group,the operation time was prolonged[(253.05±70.09)min vs(227.16±93.10)min,t=1.506,P=0.048],the intraoperative bleeding volume was increased[(284.06±233.43)ml vs(192.84±323.57)ml,t=2.049,P=0.042],the number of lymph node dissections was reduced[(12.84±3.39)vs(14.78±6.30),t=-2.439,P=0.016],the postoperative fasting time was prolonged[(4.76±1.13)d vs(4.25±1.04)d,t=3.012,P=0.003],the postoperative exhaust time was prolonged[(4.31±1.35)d vs(3.89±0.94)d,t=2.316,P=0.022],the gastric tube retention time was increased[(3.05±2.06)d vs(2.46±1.18)d,t=2.235,P=0.027],and the postoperative hospitalization time was increased[(14.56±6.09)d vs(12.72±5.55)d,t=2.011,P=0.046]in the high VFA group.The incidence of postoperative complications in the high VFA group was significantly higher than that in the low VFA group(27.5%vs 14.8%,χ^(2)=3.888,P<0.05).High VFA was identified as significant prognostic factors for poorer cumulative overall survival(62.4%vs 78.9%)and cumulative disease-free survival(57.5%vs 75.9%),and the differences between the two groups were statistically significant(P<0.05).Conclusions Abdominal VFA is of certain value in the evaluation of postoperative prognosis of rectal cancer.E

关 键 词：内脏脂肪面积 直肠肿瘤 术后并发症 预后 

分 类 号：R735.37[医药卫生—肿瘤]