内脏肥胖对机器人直肠癌根治术后近期疗效的影响  

Effect of visceral obesity on the short-term outcomes following robotic-assisted radical resection of rectal cancer

作　　者：张雪涛 李亮[2] 杨仁意 孟永康 孙佳豪 杜书祥 赵英志 徐冬利[2] 张伟 吴刚 Xuetao Zhang;Liang Li;Renyi Yang;Yongkang Meng;Jiahao Sun;Shuxiang Du;Yingzhi Zhao;Dongli Xu;Wei Zhang;Gang Wu(Department of Gastrointestinal Surgery,People's Hospital of Zhengzhou University(Henan Provincial People's Hospital),Zhengzhou 450003,China;Department of General Surgery,Cancer Hospital of Zhengzhou University(Cancer Hospital of Henan Province),Zhengzhou 450008,China)

机构地区：[1]郑州大学人民医院胃肠外科(河南省人民医院)胃肠外科,郑州市450003 [2]郑州大学肿瘤医院普外科(河南省肿瘤医院)普外科

出　　处：《中国肿瘤临床》2023年第22期1153-1158,共6页Chinese Journal of Clinical Oncology

基　　金：河南省医学科技攻关计划项目(编号:SBGJ202102028)资助。

摘　　要：目的:探讨内脏肥胖对达芬奇机器人直肠癌根治术近期疗效的影响。方法:回顾性分析2019年11月至2022年6月郑州大学人民医院和郑州大学肿瘤医院收治169例行达芬奇机器人手术的直肠癌患者的临床及病理资料,以内脏脂肪面积≥100 cm^(2)作为定义内脏肥胖的标准,将患者分为内脏肥胖组和非内脏肥胖组,评价两组的近期疗效,应用单因素和多因素Logistic回归分析术后并发症的影响因素。结果:纳入169例患者中,内脏肥胖组93例,非内脏肥胖组76例,两组基线资料比较差异均无统计学意义(均P>0.05)。非内脏肥胖组无中转开腹病例,内脏肥胖组中转开腹率为1.1%(1/93);内脏肥胖组二次手术率为2.2%(2/93),非内脏肥胖组二次手术率为1.3%(1/76),两组比较差异均无统计学意义(均P>0.05)。两组手术时间、术中出血量、淋巴结清扫数目和术后总并发症发生率比较差异均无统计学意义(均P>0.05),多因素Logistic回归分析提示营养风险筛查2002(NRS2002)评分≥3分是术后并发症的独立危险因素(OR=3.190,95%CI:1.240~8.210;P=0.016)。结论:NRS2002评分≥3分是机器人直肠癌根治术后并发症的独立危险因素,机器人手术平台可以克服肥胖相关限制,对于内脏肥胖型直肠癌患者同样安全、有效。Objective:To investigate the effect of visceral obesity on the short-term curative effect of Da Vinci robotic-assisted radical resection for rectal cancers.Methods:Clinical and pathological data of patients with rectal cancer undergoing Da Vinci robotic-assisted surgery,admitted to People's Hospital of Zhengzhou University and Cancer Hospital of Zhengzhou University from November 2019 to June 2022 were retrospectively analyzed.Visceral fat area(VFA)≥100 cm^(2)was used as the standard to define visceral obesity.Patients were categorized into visceral and non-visceral obesity groups.The short-term efficacy of the two groups was evaluated,and the influencing factors of postoperative complications were analyzed using univariate and multivariate Logistic regression.Results:Among a total of 169 patients,93 were included in the visceral obesity group and 76 in the non-visceral obesity group.There was no significant difference in the baseline data between the two groups(P>0.05).There was no conversion to laparotomy in the non-visceral obesity group,and the conversion rate was 1.1%(1/93)in the visceral obesity group.The second operation rate was 2.2%(2/93)in the visceral obesity group and 1.3%(1/76)in the non-visceral obesity group with no statistical difference between the two groups.There were no significant differences in the operation duration,intraoperative blood loss,number of lymph node dissections,and total postoperative complication rate between the two groups(P>0.05).Multivariate Logistic regression analysis revealed that an NRS≥3 independently contributed as a risk factor for postoperative complications(OR=3.190,95%CI:1.240−8.210,P=0.016).Conclusions:An NRS≥3 is an independent risk factor for complications post-robotic radical rectal cancer surgery.The robotic surgical platform can overcome obesity-related limitations and is equally safe and effective for patients with visceral obesity presenting with rectal cancer.

关 键 词：达芬奇机器人手术 直肠癌 内脏肥胖 内脏脂肪面积 

分 类 号：R735.37[医药卫生—肿瘤]