内脏脂肪增多对腹腔镜辅助远端胃癌根治术围手术期的影响

Effect of increased visceral fat on the perioperative period of laparoscopic-assisted distal gastric cancer radical resection

目的:探讨过高的内脏脂肪面积(VFA)对腹腔镜辅助远端胃癌根治术(LADG)术中风险及术后结局的影响。方法:回顾性选取2017年6月—2018年3月于首都医科大学附属北京友谊医院普通外科行LADG的患者82例,根据术前CT计算所得VFA值将患者分为两组:高VFA组( n=31)和低VFA组( n=51),其中高VFA组患者的VFA≥100 cm^(2),低VFA组患者的VFA<100 cm^(2)。统计对比两组患者在手术时间、出血量、淋巴结清扫数目以及术后并发症(包括肠梗阻、吻合口瘘、胰瘘以及腹腔感染等)方面的差异。计量资料以均数±标准差( Mean± SD)表示,组间比较采用 t检验;计数资料组间比较采用 χ2检验。胰瘘相关因素采用单因素方差分析,并将存在差异的因素以自变量纳入多因素Logistic回归分析。 结果:在手术出血量( P=0.061)、淋巴结清扫( P=0.089)、术后吻合口漏( P=0.210)、肠梗阻( P=0.275)及腹腔感染( P=0.130)方面,两组患者比较差异均无统计学意义( P>0.05),但与低VFA组相比,高VFA组患者的手术时间延长[(258±91)min vs (230±82) min, P=0.018],胰瘘发病率显著增高(11/31 vs 3/51, P=0.001),两组间差异均具有统计学意义( P<0.05)。单因素分析结果显示,性别及VFA是胰瘘发生的危险因素;多因素分析结果显示,VFA是胰瘘发生的预测因子。 结论:过高的VFA能够延长LADG手术时间,在预测术后胰瘘的发生方面更有价值。

Objective:To explore the effect of excessive visceral fat area(VFA)on the intraoperative risk and postoperative outcome of laparoscopic-assisted distal gastric cancer surgery(LADG).Methods:A retrospective selection of 82 patients who underwent LADG at the Department of General Surgery,Beijing Friendship Hospital,Capital Medical University from June 2017 to March 2018 was selected.The patients were divided into two groups according to the VFA value calculated by preoperative CT:high VFA group(n=31)and the low VFA group(n=51).Patients in the high-VFA group had VFA≥100 cm^(2),and those in the low-VFA group had VFA<100 cm^(2).The differences in operation time,blood loss,number of lymph node dissections,and postoperative complications(including intestinal obstruction,anastomotic fistula,pancreatic fistula,and abdominal infection)were statistically compared between the two groups.Measurement data were expressed as mean±standard deviation(Mean±SD),comparison between groups was by t-test;comparison of count data between groups was by Chi-square test.The factors related to pancreatic fistula were tested by one-way variance test,and the factors with differences were entered into the multivariate Logistic regression analysis as independent variables.Results:In terms of surgical bleeding(P=0.061),lymph node dissection(P=0.089),postoperative anastomotic leakage(P=0.210),intestinal obstruction(P=0.275)and abdominal infection(P=0.130),the comparison between the two groups showed no significant statistical difference(P>0.05),but compared with the low VFA group,the operation time of the high VFA group was prolonged[(258±91)min vs(230±82)min,P=0.018],and the onset of pancreatic fistula rate was significantly higher(11/31 vs 3/51,P=0.001),and there was statistical significance between the two groups(P<0.05).The results of univariate analysis showed that gender and VFA were risk factors for pancreatic fistula;the results of multivariate analysis showed that VFA was a predictor of pancreatic fistula.Conclusion:Excessive VFA prolongs LADG operation time and is more valuable in predicting the occurrence of postoperative pancreatic fistula.