肥胖对腹腔镜辅助胃癌根治术临床疗效的影响

Impact of obesity on laparoscopic-assisted radical gastrectomy for gastric cancer

目的探讨肥胖对腹腔镜辅助胃癌根治术近期疗效的影响。方法回顾性分析2007年5月至2010年6月间在福建医科大学附属协和医院接受腹腔镜辅助胃癌根治术的531例患者的临床资料，其中BMI大于或等于25kg／m^2者83例（肥胖组），小于25kg／m^2者448例（非肥胖组）。比较两组患者术中、术后及近期生存情况。结果肥胖组与非肥胖组患者中转开腹率分别为2．4％（2／83）和1．8％（8／448），差异无统计学意义（P〉O．05）。除手术时间肥胖组高于非肥胖组外[（224．7±57．3）min比（210．0±57．9）min，P〈O．05]，两组术中出血量、术中输血率、术后第1天白细胞和中性粒细胞增加数、体温恢复时间、肛门排气时间及术后住院时间的差异均无统计学意义（均P〉0．05）。肥胖组平均淋巴结清扫数目为（24．8±8．4）枚／例，明显少于非肥胖组的（29．9±10．2）枚／例（P〈O．05）。肥胖组与非肥胖组术后并发症发生率分别为16．8％（14／83）和10．2％（46／448），围手术期死亡率分别为1．2％（1／83）和0．4％（2／448）。3年生存率分别为68．8％和74．0％．差异均无统计学意义（均P〉O．05）。结论肥胖虽然会延长腹腔镜胃癌根治术的手术时间．但并不会影响手术安全性和近期疗效。

Objective To study the impact of obesity on the short-term outcomes after laparoscopic：assisted radical gastrectomy. Methods A total of 531 gastric cancer patients underwent radical resection at the Fujian Medical University Union Hospital between May 2007 and June 2010. There were 83 patients with BMI~〉25 kg/m：（obese group） and 448 patients with BMI〈25 kg/m2 （non-obese group）. Intraoperative and postoperative parameters, and short-term survival rates between the two groups were compared. Results There was no significant difference between obese and non- obese patients in terms of conversion rate （2.4% vs. 1.8%, P〉0.05）. The operative time in obese group was （224.7±57.3）rain, which was significantly longer than that in non-obese group [（210.0± 57.9） min, P〈0.05 ]. However, no statistically significant differences were observed between obese and non-obese groups in terms of blood loss, blood transfusion rate, elveated leukocyte and granulocyte count on the first postoperative day, time to temperature recovery, first flatus, and postoperative hospital stays （P〉0.05）. The mean number of retrieved lymph nodes in obese group was （24.8±8.4）, and was significantly less than that of non-obese group [（29.9±10.2）,P〈0.05]. There were no significant differences between obese and non-obese groups in postoperative complication rate （16.8% vs. 10.2%, P〉0.05）, postoperative mortality （1.2% vs. 0.4%, P〉0.05）, and 3-year overall survival （68.8% vs. 74.0%, P〉0.05）. Conclusions Obesity is associated with prolonged operative time for laparoscopic radical gastrectomy. However, the short-term outcomes after the laparoscopic radical gastrectomy is not influenced by obesity.