CT测量内脏脂肪面积对腹腔镜胃癌切除术后发生并发症的预测价值

Value of visceral fat area measured by CT to the prediction of complications after laparoscopic-assisted radical gastrectomy

目的记录胃癌患者术前腹部CT测量的内脏脂肪面积(visceral fat area,VFA)和体质量指数(body mass index,BMI),探讨二者对术后并发症的预测价值。方法行腹腔镜全胃切除术/胃部分切除术的胃癌患者134例,术前均行腹部CT扫描测量VFA,并计算BMI。依据BMI将134例患者分为超重组54例(BMI≥25 kg/m^(2))和非超重组(BMI<25 kg/m^(2))80例,依据VFA将134例患者分为内脏肥胖组(VFA≥100 cm^(2))73例和非内脏肥胖组(VFA<100 cm^(2))61例。比较超重组与非超重组、内脏肥胖组与非内脏肥胖组临床分期、病理分级、肿瘤部位、肿瘤直径、ASA分级、合并症、手术方式、手术时间、术中出血量、淋巴结捡取数、术后排气时间、术后3 d引流量、术后住院时间及术后并发症发生情况;绘制ROC曲线,评估VFA、BMI预测腹腔镜全胃切除术/胃部分切除术后发生并发症的效能。结果超重组与非超重组、内脏肥胖组与非内脏肥胖组性别、年龄、临床分期、病理分级、肿瘤部位、肿瘤直径、ASA分级及合并糖尿病、高血压、高脂血症比率比较差异均无统计学意义(P>0.05)。超重组手术时间[(279.35±20.15)min]长于非超重组[(262.30±26.81)min](t=3.259,P=0.016),手术方式、术中出血量、淋巴结捡取数、术后排气时间、术后3 d引流量、术后住院时间与非超重组比较差异均无统计学意义(P>0.05)。内脏肥胖组手术时间[(282.50±25.48)min]长于非内脏肥胖组[(257.95±22.81)min](t=4.392,P=0.008),术中出血量[(110.55±15.03)mL]、术后3 d引流量[(139.82±8.44)mL]均多于非内脏肥胖组[(78.70±13.59)、(86.10±6.41)mL](t=6.219,P<0.001;t=4.410,P=0.004),手术方式、淋巴结捡取数、术后排气时间、术后住院时间与非内脏肥胖组比较差异均无统计学意义(P>0.05)。超重组切口脂肪液化、术后出血、吻合口瘘、吻合口出血、胰瘘、胃排空延迟等发生率与非超重组比较差异均无统计学意义(P>0.05);内脏肥胖组切口脂肪液化发生率(12.33%)高于非内脏肥胖组(1.64%)(χ^(2)=4.060,P=0.044),术后出血、吻合口瘘等并发症发生率与非内脏肥胖组比较差异均无统计学意义(P>0.05)。VFA、BMI分别以128.43 cm^(2)、23.47 kg/m^(2)为最佳截断值,预测腹腔镜全胃切除术/胃部分切除术后发生并发症的AUC分别为0.947(95%CI:0.900~0.994,P<0.001)、0.681(95%CI:0.577~0.786,P=0.002),灵敏度分别为93.8%、83.6%,特异度分别为88.5%、77.9%;VFA预测腹腔镜全胃切除术/胃部分切除术后发生并发症的AUC大于BMI(Z=3.351,P=0.029)。结论胃癌患者VFA≥100 cm^(2)时手术时间长、术中出血量及术后引流量大、术后切口脂肪液化发生率高;VFA预测腹腔镜全胃切除术/胃部分切除术后并发症发生的效能优于BMI。

Objective To record the visceral fat area(VFA)and body mass index(BMI)measured by preoperative abdominal CT,and to investigate their values to the prediction of postoperative complications in patients with gastric cancer.Methods A total of 134patients underwent laparoscopic-assisted total/partial gastrectomy.Before operation,abdominal CT scan was performed to measure VFA,and the BMI was calculated.According to BMI and VFA values,134patients were divided into 54 patients with BMI≥25 kg/m^(2)(overweight group)and 80 patients with BMI<25kg/m^(2)(non-overweight group),as well as into 73patients with VFA≥100cm^(2)(visceral obesity group)and61patients with VFA<100cm^(2)(non-visceral obesity group).The clinical stage,pathological grade,tumor location,tumor diameter,ASA classification,complications,surgical methods,operation lasting time,intraoperative blood loss,number of resected lymph nodes,postoperative exhaust time,postoperative 3-d drainage volume,length of postoperative hospital stay and postoperative complications were compared between overweight and non-overweight groups as well as between visceral obesity and non-visceral obesity groups.ROC curve was drawn to evaluate the values of VFA and BMI to the prediction of laparoscopic-assisted total/partial gastrectomy.Results There were no significant differences in the gender,age,clinical stage,pathological grade,tumor location,tumor diameter,ASA grade,and percentages of patients with diabetes,hypertension and hyperlipidemia between overweight and non-overweight groups as well as between visceral obesity and non-visceral obesity groups(P>0.05).The operation lasting time was longer in overweight group[(279.35±20.15)min]than that in non-overweight group[(262.30±26.81)min](t=3.259,P=0.016),and there were no significant differences in the operation method,intraoperative blood loss,number of resected lymph nodes,postoperative exhaust time,postoperative 3-d drainage volume,and length of postoperative hospital stay between two groups(P>0.05).The operation lasting time was longer in visceral obesity group[(282.50±25.48)min]than that in non-visceral obesity group[(257.95±22.81)min](t=4.392,P=0.008),the intraoperative blood loss and postoperative 3-d drainage volume were larger in visceral obesity group[(110.55±15.03),(139.82±8.44)mL]than those in non-visceral obesity group[(78.70±13.59),(86.10±6.41)mL](t=6.219,P<0.001;t=4.410,P=0.004),and there were no significant differences in the operation method,number of resected lymph nodes,postoperative exhaust time and length of postoperative hospital stay between two groups(P>0.05).There were no significant differences in the incidences of incisional fat liquefaction,postoperative bleeding,anastomotic leakage,anastomotic bleeding,pancreatic fistula,and delayed gastric emptying between overweight and non-overweight groups(P>0.05).The incidence of incisional fat liquefaction was higher in visceral obesity group(12.33%)than that in non-visceral obesity group(1.64%)(χ^(2)=4.060,P=0.44),and the incidences of postoperative bleeding,anastomotic leakage and other complications showed no significant differences between two groups(P>0.05).When the optimal cut-offvalues of VFA and BMI were 128.43cm^(2) and 23.47kg/m^(2),and the AUCs for predicting postoperative complications were 0.947(95%CI:0.900-0.994,P<0.001)and 0.681(95%CI:0.577-0.786,P=0.002),the sensitivities were 93.8% and 83.6%,and the specificities were 88.5% and 77.9%,respectively.The AUCof VFA was greater than that of BMI(Z=3.351,P=0.029).Conclusion The patients with VFA≥100cm^(2) have a long operation lasting time,large intraoperative bleeding,large postoperative drainage volume and high incidence of incisional fat liquefaction,and VFA is superior to BMI in predicting the complications after laparoscopic-assisted total/partial gastrectomy.