内脏脂肪面积与直肠癌术后短期结局指标的相关性

Correlation Between Visceral Fat Area and Postoperative Short-Term Outcomes for Rectal Cancer

目的评估内脏脂肪面积(VFA)与腹腔镜直肠癌根治手术及术后短期结局指标的相关性。方法回顾性分析2018年7月至2021年6月在新乡医学院第一附属医院就诊并手术治疗的直肠癌患者的临床资料,共230例患者纳入本研究。VFA诊断肥胖的截断值为100 cm^(2),VFA≥100 cm^(2)为腹型肥胖。将患者按照VFA分为两组,分析两组间手术相关指标的差异,包括吻合口瘘发生率、术中出血量、中转开腹率、术后出血、再次手术率、手术时间、住院时间。结果研究对象中腹型肥胖共61例。腹型肥胖患者术后吻合口瘘发生率(23.0%比5.3%,P<0.001)和中转开腹率(14.8%比3.6%,P=0.005)较非腹型肥胖患者高。经单因素分析和多因素logistic分析,VFA≥100 cm^(2)(OR=6.373,95%CI 2.419~17.922,P<0.001)、年龄≥60岁(OR=3.877,95%CI 1.366~12.979,P=0.016)、肿瘤下缘距肛缘距离≤5 cm(OR=0.203,95%CI 0.053~0.616,P=0.009)和术前放化疗(OR=3.841,95%CI 1.453~10.984,P=0.008)是吻合口瘘发生的独立危险因素。结论VFA与腹腔镜直肠癌手术中转开腹相关,同时也是吻合口瘘发生的独立危险因素,能较好地预测术后并发症的发生,指导临床工作。

Objective To evaluate the correlation between visceral fat area(VFA) and short-term outcomes after laparoscopic radical resection in patients with rectal cancer.Methods Two hundred and thirty patients diagnosed with rectal cancer and underwent laparoscopic radical resection between July 2018 and June 2021 in the First Affiliated hospital of XinXiang Medical University were included in this study,and the perioperative clinical data of them were retrospectively collected.The VFA cutoff point for diagnosing obesity was 100 cm^(2),and patients with VFA≥100 cm^(2) were diagnosed as abdominal obesity.Patients were grouped by VFA,postoperative data were analyzed between each group including anastomotic leakage rate,blood loss volume,conversion to open surgery rate,postoperative bleeding,reoperation,duration of surgery and length of stay.Results Sixty-one patients were abdominal obesity.The abdominal obesity patients had much higher anastomotic leakage rate(23.0% vs.5.3%,P<0.001) and conversion to open surgery rate(14.8% vs.3.6%,P=0.005) than patients with non-abdominal obesity.Univariable and multivariable analysis was conducted to find that VFA≥100 cm^(2)(OR=6.373,95% CI 2.419-17.922,P<0.001),age≥60 years(OR=3.877,95% CI 1.366-12.979,P=0.016),tumor distance from anal verge ≤ 5 cm(OR=0.203,95% CI 0.053-0.616,P=0.009) and preoperative chemoradiotherapy(OR=3.841,95% CI 1.453-10.984,P=0.008) were the independent risk factors for anastomotic leakage.Conclusion VFA is associated with an increased risk of conversion to open surgery,it is also an independent risk factor for anastomotic leakage.It can better predict the occurrence of postoperative complications and guide the clinical work.