腹部内脏脂肪面积对根治性胃癌切除术后患者预后诊断价值

Prognostic significance of abdominal visceral fat area for radical gastrectomy after resection

目的探讨腹部内脏脂肪面积在评估根治性胃癌切除术后患者预后的诊断价值。方法收集2015年1月~2016年12月期间在我院诊断为胃癌并行根治性手术切除患者263例,计算第三腰椎层面内腹部内脏脂肪的总面积(visceral fat area,VFA)。根据体质指数(Body Mass Index,BMI)分为高BMI组(66例)和BMI正常组(197例),根据内脏脂肪面积将患者分为高VFA组(121例)和低VFA组(142例)。比较不同组别患者一般临床病理资料、术后近期及远期疗效,使用单因素及多因素分析影响患者预后的危险因素。结果高BMI组较BMI正常组高血压及糖尿病病例多、手术时间长、术中出血量多、行腹腔镜手术患者少(P<0.05),在肿瘤大小、分期、分化程度及总体预后与BMI正常组比较差异均无统计学意义(P>0.05)。高VFA组与低VFA组高血压病例、肿瘤最大直径、肿瘤分期、手术时间、手术出血量、术后检出淋巴结数目、术后发生ⅡIA级及以上并发症人数、行腹腔镜手术患者、术后总体生存时间相比较差异有统计学意义(P<0.05);患者总体生存情况单因素分析发现肿瘤T分期、N分期、是否有脉管癌栓侵犯、肿瘤大小、肿瘤TNM分期及VFA是根治胃癌切除术后患者预后的危险因素;多因素分析发现T分期、N分期、肿瘤大小是根治胃癌切除术后患者预后的危险因素。结论高腹部内脏脂肪面积是胃癌患者术后不良预后的危险因素之一,可作为根治性胃癌切除术后患者预后的评估指标。

Objective To investigate the prognostic value of abdominal visceral fat area for the patients underwent radical gastric cancer after resection.Methods A total of 263 patients who underwent radical resection of gastric cancer in our hospital from January 2015 to December 2016 were enrolled,and the area of visceral fat (VFA) was detected.The patients were divided into high body mass index (BMI) and normal BMI,and divided into high VFA and low VFA groups.The clinical and pathological data,short-term efficacy and long-term efficacy of patients were compared between two groups.Univariate and multivariate analysis were used to test the independent factor of the prognosis of patients.Results There were 121 patients in the high VFA group and 66 in the high BMI group.The patients in the BMI group had high blood pressure and diabetes,long operation time,high blood loss during operation,and few patients undergoing laparoscopic surgery( P <0.05).No difference was found in tumor size,stage,differentiation and overall survival in the two BMI groups( P >0.05).In the high VFA group,more patients had hypertensive and larger tumor,higher stage,longer operation time,more blood loss,smaller number of detected lymph nodes after operation,more ⅡIA or above complications after surgery.And the patients in the higher VFA groups had few patients with laparoscopic surgery and shorter overall survival time,P <0.05.Univariate analysis of overall survival of patients found that VFA is a risk factor for prognosis in patients undergoing radical resection of gastric cancer.Conclusion Abdominal visceral fat area can be used as a prognostic indicator for postoperative patients with radical gastric cancer resection.