腹部内脏脂肪面积对腹腔镜辅助胃癌根治术后围手术期并发症及临床相关胰瘘的影响  

The effect of abdominal visceral fat area on perioperative complications and pancreatic fistula in primary gastric carcinoma patients after laparoscopic assisted radical gastrectomy

作　　者：田庆[1] 胡晓林[1] 刘世江[1] 刘汇明[1] 刘凯[1] 冯勇[1] Tian Qing;Hu Xiaolin;Liu Shijiang;Liu Huiming;Liu Kai;Feng Yong(Department of Hepatobiliary Gastrointestinal Surgery,Shouguang People's Hospital,Weifang 262700,China)

机构地区：[1]寿光市人民医院肝胆胃肠科,潍坊262700

出　　处：《中华普通外科杂志》2023年第5期357-361,共5页Chinese Journal of General Surgery

基　　金：潍坊市卫生健康委员会科研计划项目(WFWSJK-2020-126)。

摘　　要：目的对比不同内脏脂肪面积(VFA)患者腹腔镜胃癌根治术后并发症及胰瘘的危险因素。方法回顾性分析2017年1月至2022年1月寿光市人民医院普外科214例原发性胃癌行腹腔镜辅助胃癌根治术患者的临床资料,其中高VFA组患者85例,低VFA组患者129例。结果高VFA组患者BMI[(25.1±3.4)kg/m2]、内脏脂肪面积[(143.4±41.1)cm2]较低VFA组患者BMI[(21.2±2.9)kg/m2]、内脏脂肪面积[(58.7±31.9)cm2]大(均P<0.05);高VFA组患者手术时间为(228.3±53.1)min,低VFA组为(206.3±62.9)min(t=5.538,P=0.017);高VFA组患者术中出血量为(264.6±173.6)ml,低VFA组为(213.9±156.2)ml(t=3.373,P=0.035);高VFA组患者术后住院时间为(12.5±4.0)d,低VFA组为(10.3±3.7)d,差异有统计学意义(t=7.781,P=0.013);高VFA组患者术后出现并发症23例,低VFA组患者20例(χ^(2)=4.261,P=0.039);高VFA组患者术后胰瘘的发生率为10.6%,低VFA组为3.1%(χ^(2)=5.034,P=0.038)。多因素分析结果显示,VFA男性≥134.6 cm2、VFA女性≥91.1 cm2、手术时间≥250 min是影响术后胰瘘发生的独立危险因素。结论VFA较大的患者腹腔镜辅助胃癌根治术后并发症增加;VFA和手术时间是影响胃癌根治术后发生胰瘘的独立危险因素。Objective To study the effect of visceral fat area(VFA)on postoperative complications and pancreatic fistula in patients undergoing laparoscopic assisted radical gastrectomy for gastric careinoma.Methods Clnical data of 214 primary gastric cancer patients undergoing laparoscopic assisted radical gastrectomy between Jan 2017 and Jan 2022 at the Department of General Surgery,Shouguang People's Hospital were retrospectively reviewed.Results There were 85 patients in high VFA group and 129 patients in the low VFA group.The body mass index(25.1±3.4)kg/m2 and visceral fat area(143.4±41.1)cm2 in the high VFA group were higher than those in the low VFA group(21.2±2.9)kg/m2 and visceral fat area(58.7±31.9)cm2.The operative time was(228.3±53.1)min vs.(206.3±62.9)min(t=5.538,P=0.017).The intraoperative blood loss was(264.6±173.6)ml vs.(213.9±156.2)ml(t=3.373,P=0.035).The postoperative hospital stay was(12.5±4.0)d vs.(10.3±3.7)d(t=7.781,P=0.013).Twenty-three cases developed postoperative complications in the high VFA group vs.20 cases in the low VFA group(χ^(2)=4.261,P=0.039).Patients in the high VFA group had an incidence of clinically relevant pancreatic fistula of 10.6%vs.3.1%in patients in the low VFA group(χ^(2)=5.034,P=0.038).Univariate and multivariate analysis of clinically relevant pancreatic fistulas in patients with different VFA groups showed that men≥134.6 cm2 and women≥91.1 cm2 with VFA and operative time≥250 min were independent risk factors for the occurence of clinically relevant pancreatic fistulas after laparoscopic assisted radical gastrectomy.Conclusions VFA increases the difficulty of laparoscopic-assisted radical gastrectomy,resulting in increased postoperative complications.VFA and operation time are independent risk factors for clinically relevant pancreatic fistula after radical gastrectomy for gastric cancer.

关 键 词：胃肿瘤 腹部脂肪 胰瘘 手术后并发症 

分 类 号：R735.2[医药卫生—肿瘤]