体质指数增加对胃癌根治术近期临床疗效的影响

Effects of increased body mass index on immediate clinical efficacy of radical gastrectomy

目的 探讨胃癌患者体质指数（BMI）的增加对胃癌根治术的根治效果及生存结果的影响.方法 回顾性收集2009年1月至2013年1月在新疆医科大学附属肿瘤医院行胃癌根治术的258例患者,BMI进行分组：肥胖组（BMI≥25 kg/m^2） 118例,非肥胖组（BMI＜ 25 kg/m^2） 140例.对比两组患者术中和术后情况及近期生存的情况.结果 肥胖组与非肥胖组手术时间[（208.6±60.8）min与（178.1 ±62.5） min]的比较及两组淋巴结清扫数[（23.4±8.3）与（29.8±12.2）个]的比较,差异有统计学意义.两组术中出血量、术后总并发症、转移淋巴结清扫数的比较,差异均无统计学意义.两组患者累计生存率比较,差异无统计学意义.结论 肥胖不是影响胃癌预后的独立危险因素,术前积极处理好肥胖引起的相关并发症,术中严格操作,术后给予营养支持并积极处理原发疾病,可以降低患者术后并发症的风险,改善预后,同样可以达到根治效果,不影响患者近期生存时间.

Objective To explore the effects of increased body mass index （BMI） on immediate clinical efficacy of radical gastrectomy in patients with gastric cancer.Methods The data of 258 patients undergoing radical gastrectomy were collected retrospectively from January 2009 to January 2013.They were grouped byBMI into obese （BMI≥25 kg/m^2,n =118） and non-obese （BMI 〈25 kg/m^2,n =140） groups.And their intra and post-operative findings and survivals were compared between two groups.Followups until January 2014 were conducted by outpatient visits,mail and telephone.SPSS 17.0 software was used for statistical analysis.Results For obese and non-obese groups,operative durations were （208.6 ±60.9）,（178.1 ±62.5） min and number of lymph node dissection （23.4 ± 8.3）,（29.8 ± 12.2） pieces respectively.And the difference was statistically significant （P 〈 0.05）.And blood loss,overall incidence of postoperative complications,the number of metastatic lymph node dissection were （272.4 ± 128.8） ml,30.5% （36/118）,（7.9±8.8） pieces and （260.8 ±160.4） ml,24.3%（34/140）,（8.6 ±10.2） pieces respectively.And the differences were not statistically significant （P 〉 0.05）.The median follow-up period was 23 months.And the difference of cumulative survival was not statistically significant （χ^2 =1.199,P =0.274）.Conclusions Obesity is not an independent prognostic foactor for gastric cancer.But its related complications should be actively handled preoperatively.Intraoperative procedures are strictly performed.And postoperative nutritional supports are needed to lower the incidence of complications and imporve the prognosis.