腹腔镜直肠癌前切除术在肥胖患者的临床应用

Laparoscopic anterior resection of rectal cancer in obese patients

目的分析肥胖患者行腹腔镜直肠癌前切除术的短期疗效,评价其可行性和安全性。方法回顾性分析解放军总医院普通外科2010年1月至2011年12月142例施行腹腔镜直肠癌前切除术的临床资料。将患者分为正常体重组[体重量指数(BMI)=18.5～24.9kg/m2]、超重组(BMI=25.0～29.9kg/m2)和肥胖组(BMI≥30kg/m2),对三组手术结果、术后恢复情况及术后并发症进行比较。结果正常体重组患者54例(38.0%),超重组患者68例(47.9%)和肥胖组患者20例(14.1%)。三组患者在手术时间、术中估计出血量、术中输血率等方面差异无统计学意义(P>0.05),其中肥胖组有2例患者(10.0%)中转开腹,而正常体重组及超重组术中无中转开腹病例,差异有统计学意义(P=0.002)。淋巴结清扫情况及术后平均排气时间、进食时间及住院天数差异无统计学意义(P>0.05)。术后并发症发生率差异无统计学意义(P>0.05)。结论腹腔镜直肠癌前切除术应用于肥胖患者在技术上安全可行,能满足肿瘤根治的要求。

Objective To analyze the short-term efficacy of laparoscopic anterior resection of rectal cancer in obese patients,and to evaluate its feasibility and safety.Methods The clinical data of 142 patients with rectal cancer who had undergone laparoscopic anterior resection in our hospital from January 2010 to December 2011 were analyzed retrospectively.The patients were divided into normal-weight group（NW,BMI（body mass index）=18.5～24.9 kg/m2）,overweight group（OW,BMI=25.0～29.9 kg/m2） and obese group（OB,BMI≥30 kg/m2）.The perioperative outcomes,oncologic parameters and postoperative complications were compared among the three groups.Results There were 54 patients（38.0%） in the NW group,68 patients（47.9%） in the OW group and 20 patients（14.1%） in the OB group.There was no significant difference in operation time,intraoperative blood loss and rate of blood transfusion among the three groups（P0.05）.Conversion rates were 10.0%（2/20） in the OB group;however none of the patients underwent conversion in the NW and OW groups（P=0.002）.In the number of scavenged lymph nodes,first flatus,oral intake and postoperative hospital stay,no significant difference was found in the 3 groups（P0.05）.There was no significant difference in the incidence of postoperative complications in the 3 groups（P0.05）.Conclusions Laparoscopic anterior resection of rectal cancer is safe and feasible for obesity patients.