肥胖对食管癌手术后早期并发症的影响

Impact of obesity on early postoperative complications of esophageal cancer

目的：探讨肥胖对食管癌手术患者术后早期并发症的影响。方法回顾性分析威海市中心医院2012年8月至2015年9月住院行食管癌手术患者的病历资料，共327例。按照体质量指数（BMI）将患者分为四组：消瘦组（n ＝75）、正常组（n ＝120）、超重组（n ＝103）、肥胖组（n ＝29）。分析肥胖对食管癌手术后早期并发症的影响。结果消瘦组、正常组、超重组、肥胖组手术时间分别为（257．8±52．6）min、（289．3±48.7）min、（321．5±55．9）min、（367．9±50．2）min，手术操作时间随着体质指数的增加相应地延长（F ＝13.397，P ＝0．000）；消瘦组切口感染、脓胸、声音嘶哑、膈疝、术后出血、乳糜漏、肺部并发症发生率分别为5.3％、1．3％、1．3％、1．3％、2．7％、2．7％、16．0％，正常组分别为5．0％、1．6％、1．6％、1．3％、1．6％、1．6％、17．5％，超重组分别为5．8％、1．9％、0．9％、1．9％、1．9％、1．9％、1．9％，肥胖组分别为10．3％、3．4％、0．0％、3．4％、3．4％、0．0％、13．8％，四组差异均无统计学意义（均 P ＞0．05）；消瘦组心血管并发症、吻合口漏发生率分别为0．0％、4．0％，正常组分别为1．9％、5．0％，超重组分别为6．8％、9．7％，肥胖组分别为13．8％、17．2％，心血管并发症发生率、术后吻合口漏发生率随 BMI 的增大而增加，四组差异均有统计学意义（F ＝1．675、1.054，均 P ＜0．05）。结论肥胖可使患者食管癌术后早期并发症发生率增加。但是肥胖不是食管癌手术的禁忌证，但对肥胖患者在围手术期的处理应该更加慎重。

Objective To investigate the effect of obesity on the early complications after esophageal cancer operation.Methods Clinical data of 327 patients who had esophageal cancer operation in our hospital from August 2012 to September 2015 were retrospectively analyzed.The patients were divided into 4 groups：lean group（n =75）, normal group（n =120）,overweight group（n =103）and obesity group（n =29）by body mass index（BMI）.The impact of obesity on early complications of esophageal carcinoma after surgery was analyzed.Results The operation time of the lean group,normal group,overweight group and obesity group were （257.8 ±52.6 ）min,（289.3 ± 48.7）min,（321.5 ±55.9）min,（367.9 ±50.2）min respectively.The operation time was increased with the increase of BMI （F =13.397,P =0.000）.The incidence rates of incision infection,empyema,hoarseness,diaphragmatic hernia,postoperative bleeding,chylous fistula,pulmonary complication were 5.3%,1.3%,1.3%,1.3%,2.7%, 2.7%,16.0% in the lean group,5.0%,1.6%,1.6%,1.3%,1.6%,1.6%,17.5% in the normal group,5.8%, 1.9%,0.9%,1.9%,1.9%,1.9%,1.9% in the overweight group,10.3%,3.4%,0.0%,3.4%,3.4%,0.0%, 13.8% in the obesity group.No significant differences were found about the hospital days,wound infection,empyema, hoarseness,diaphragmatic hernia,operation hemorrhage,chylous fistula,pulmonary complications among the 4 groups （all P 〉0.05 ）.The incidence rates of cardiovascular complications and anastomotic leakage after operation were 0.0%,4.0% in the lean group,1.9%,5.0% in the normal group,6.8%,9.7% in the overweight group,13.8%, 17.2% in the obesity group.The incidence of cardiovascular complications,postoperative anastomotic leakage increased with the increase of BMI.The differences of the four groups were statistically significant（F =1.675,1.054, all P 〈0.05）.Conclusion Obesity can increase the incidence of early postoperative complications in patients with esophageal cancer.But obesity is not a contraindication of surgery for esophageal cancer,but obese patients should be more carefully treated in the perioperative period.