腹部内脏脂肪面积对直肠癌手术预后评估价值的研究

Study on the value of abdominal visceral fat area in evaluating the prognosis of patients after rectal cancer surgery

目的探讨不同腹部内脏脂肪面积(VFA)的直肠癌患者围手术期恢复情况及近远期预后差异。方法回顾性分析2016年6月至2019年7月陕西省人民医院161例确诊为直肠癌且行手术治疗的患者资料。收集患者基础资料、病理资料、围手术期恢复指标以及术后随访状况,以CT值(HU)不同标记肌肉组织和脂肪组织,采用Slice-O-Matic软件得到第三腰椎层面VFA。以134.6 cm^(2)(男)和91.1 cm^(2)(女)为界值,对不同VFA组患者进行统计分析。结果与低VFA组相比,高VFA组患者手术时间延长[(253.05±70.09)min vs(227.16±93.10)min,t=1.506,P=0.048],术中出血量增加[(284.06±233.43)ml vs(192.84±323.57)ml,t=2.049,P=0.042],术中淋巴结清扫数量减少[(12.84±3.39)个vs(14.78±6.30)个,t=-2.439,P=0.016],术后禁饮食时间延长[(4.76±1.13)d vs(4.25±1.04)d,t=3.012,P=0.003],术后排气时间延长[(4.31±1.35)d vs(3.89±0.94)d,t=2.316,P=0.022],胃管留置时间增加[(3.05±2.06)d vs(2.46±1.18)d,t=2.235,P=0.027],术后住院时间增加[(14.56±6.09)d vs(12.72±5.55)d,t=2.011,P=0.046]。高VFA组患者术后总并发症发生率较低VFA组明显增加(27.5%vs 14.8%,χ^(2)=3.888,P<0.05),累积总生存率(62.4%vs 78.9%)和累积无病生存率(57.5%vs 75.9%)较低VFA组明显降低,差异均有统计学意义(P<0.05)。结论腹部VFA对直肠癌手术患者的预后评估具有一定价值,高VFA会增加直肠癌根治术难度,影响患者术后恢复和长期生存,增加患者围手术期并发症的发生风险。

Objective To assess the perioperative recovery and short-and long-term postoperative outcomes of rectal cancer patients with different abdominal visceral fat area(VFA).Methods A total of161 patients with rectal cancer treated by surgery in Shaanxi Provincial People’s Hospital from June 2016to July 2019 were retrospectively analyzed.The clinical baseline data,perioperative recovery indicators,follow-up status of the patitents were collected,and the CT values(hounsfield unit,HU)were used to mark muscle tissue and adipose tissue differently.The VFA of the third lumbar vertebra bedding was obtained by Slice-O-Matic software.The patients were classified to high VFA group(≥134.6 cm^(2) in males and≥91.1 cm^(2) in females)and low VFA group(<134.6 cm^(2) in males and<91.1 cm^(2) in females).Results Compared with the low VFA group,the operation time was prolonged[(253.05±70.09)min vs(227.16±93.10)min,t=1.506,P=0.048],the intraoperative bleeding volume was increased[(284.06±233.43)ml vs(192.84±323.57)ml,t=2.049,P=0.042],the number of lymph node dissections was reduced[(12.84±3.39)vs(14.78±6.30),t=-2.439,P=0.016],the postoperative fasting time was prolonged[(4.76±1.13)d vs(4.25±1.04)d,t=3.012,P=0.003],the postoperative exhaust time was prolonged[(4.31±1.35)d vs(3.89±0.94)d,t=2.316,P=0.022],the gastric tube retention time was increased[(3.05±2.06)d vs(2.46±1.18)d,t=2.235,P=0.027],and the postoperative hospitalization time was increased[(14.56±6.09)d vs(12.72±5.55)d,t=2.011,P=0.046]in the high VFA group.The incidence of postoperative complications in the high VFA group was significantly higher than that in the low VFA group(27.5%vs 14.8%,χ^(2)=3.888,P<0.05).High VFA was identified as significant prognostic factors for poorer cumulative overall survival(62.4%vs 78.9%)and cumulative disease-free survival(57.5%vs 75.9%),and the differences between the two groups were statistically significant(P<0.05).Conclusions Abdominal VFA is of certain value in the evaluation of postoperative prognosis of rectal cancer.Elevated abdominal VFA may increase the difficulty of radical resection for rectal cancer,affect the postoperative recovery and long-term survival of patients,and is associated with adverse postoperative outcome.