内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响  

Effects of visceral obesity on early complications after laparoscopic radical resection for rectal cancer

作　　者：赵丽霞 王春霞 陈一锋 胡东平[2] 张维胜[2] 王涛[2] 张洪来 Zhao Lixia;Wang Chunxia;Chen Yifeng;Hu Dongping;Zhang Weisheng;Wang Tao;Zhang Honglai(Gansu Clinical Research Center for Anorectal Diseases,Lanzhou Gansu Province 730000,China;Department of Anorectal,Gansu Provincial people’s Hospital,Lanzhou Gansu Province 730000,China)

机构地区：[1]甘肃省肛肠疾病临床医学研究中心,兰州730000 [2]甘肃省人民医院肛肠科,兰州730000

出　　处：《中华普外科手术学杂志(电子版)》2025年第1期35-39,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金(82160522);甘肃省自然科学基金(22JR5RA653);甘肃省自然科学基金(22JR5RA676);甘肃省肛肠疾病临床医学研究中心项目(20JR10RA434);甘肃省人民医院院内科研基金(21GSSYC-19,22GSSYD-64,21GSSYB-22)。

摘　　要：目的探究内脏型肥胖对直肠癌根治术后早期并发症的影响。方法回顾性分析2017年10月至2022年10月234例行腹腔镜直肠癌根治术患者临床病理及术前影像资料。根据内脏脂肪面积(VFA)值将患者分为内脏型肥胖组(n=108例)和非内脏型肥胖组(n=126例);比较两组患者的临床病理特征、术中术后情况及术后早期并发症等指标。采用SPSS25.0统计软件处理数据,术中和术后情况等计量资料行独立样本t检验或秩和检验;并发症发生率等计数资料行χ^(2)检验;单因素和Logistic回归模型分析影响直肠癌根治术后早期并发症发生的危险因素。P<0.05表示差异有统计学意义。结果两组患者性别、年龄、肿瘤大小、肿瘤距肛缘距离、T分期、TNM分期、分化程度、白蛋白比较差异均无统计学意义(P>0.05),内脏型肥胖组BMI高于非内脏型肥胖组,差异有统计学意义(P<0.05);两组患者术后首次通气时间、术后引流管拔除时间比较差异无统计学意义(P>0.05),内脏型肥胖较非内脏型肥胖手术时间延长、术中出血量增加、术后住院时间延长(P<0.05);内脏型肥胖患者术后易出现早期并发症(P<0.05);单因素分析结果显示VFA≥100cm2、肿瘤距肛缘距离≤5cm、TNM分期Ⅲ/Ⅳ期是术后早期并发症的危险因素(P<0.05)。结论内脏型肥胖会增加直肠癌术中出血风险、延长手术和术后住院时间,VFA≥100 cm2是直肠癌术后早期并发症发生的危险因素。Objective To explore the influence of visceral obesity on early complications after radical resection of rectal cancer.Methods The clinicopathological and preoperative imaging data of 234 patients who underwent laparoscopic radical resection for rectal cancer from October 2017 to October 2022 were retrospectively analyzed.According to visceral fat area(VFA),the patients were divided into visceral obesity group(n=108 cases)and non-visceral obesity group(n=126 cases).The clinicopathological features,intraoperative and postoperative conditions and early postoperative complications were compared between the two groups.SPSS25.0 statistical software was used to process the data,and the measurement data such as intraoperative and postoperative conditions were subjected to independent sample t test or Rank Sum test.The complication rate and other statistical data were chi-square test.Logistic regression model was used to analyze the risk factors of early complications after radical resection of rectal cancer.P<0.05 indicated that the difference was statistically significant.Results There were no significant differences in gender,age,tumor size,tumor distance from anal margin,T stage,TNM stage,differentiation degree and albumin between the two groups(P>0.05).BMI of visceral obesity group was higher than that of nonvisceral obesity group,with statistical significance(P<0.05).There was no significant difference in the first time of ventilation and the time of drainage tube removal between the two groups(P>0.05).Compared with non-visceral obesity,visceral obesity had longer operation time,more intraoperative blood loss and longer postoperative hospital stay(P<0.05).Early complications were more likely to occur in patients with visceral obesity(P<0.05).Univariate analysis showed that VFA≥100 cm2,tumor distance from anal margin≤5 cm,TNM stageⅢ/Ⅳstage were risk factors for early postoperative complications(P<0.05).Conclusion Visceral obesity can increase the risk of intraoperative bleeding,prolong operation time and pos

关 键 词：直肠肿瘤 腹腔镜 内脏型肥胖 内脏脂肪面积 术后早期并发症 

分 类 号：R735.37[医药卫生—肿瘤]