腰围对胃癌及结直肠癌患者腹腔镜术后短期预后的影响

Impact of the waist circumference on short-term outcomes after laparoscopic surgery in patients with gastric or colorectal cancers

目的 研究腰围与胃癌及结直肠癌患者腹腔镜术后并发症的相关性,旨在为腰围预测患者腹腔镜手术短期预后提供新证据。方法 回顾性纳入96例行腹腔镜下肿瘤根治术的胃癌及结直肠癌患者,将患者根据腰围分为3组,其中A组为腰围正常组(n=31),B组为中心型肥胖前期组(n=43),C组为中心型肥胖组(n=22),比较3组患者的围术期特征和手术情况,分析腰围对术后并发症发生风险的影响。结果 患者术前合并代谢综合征患病率A组为9.70%,B组为13.95%,C组为36.36%,C组高于A组、B组(P<0.05)。患者腹腔镜中转开腹手术的发生率A组为0,B组为7.00%,C组为13.60%,C组高于A组(P<0.05)。手术时间≥180 min的患者A组占41.90%,B组占55.80%,C组占77.30%,C组高于A、B组(P<0.05)。术后Clavien-DindoⅡ级及以上总并发症发生率A组为22.60%,B组为32.60%,C组为45.50%,C组高于A组(P<0.05)。感染性相关并发症发生率A组为9.70%,B组为18.60%,C组为27.30%,B、C组高于A组(P<0.05)。C组住院费用较A组增高(P<0.05)。单因素分析显示术前合并代谢综合征、腰围、营养风险评分与术后并发症发生相关(P<0.05)。多因素分析结果显示术前合并代谢综合征(P=0.002)、中心型肥胖(P=0.004)、营养风险评分≥3(P=0.004)是术后并发症发生风险的危险因素。结论 中心型肥胖是影响胃癌及结直肠癌患者腹腔镜术后并发症发生风险的重要因素,腰围对预测胃癌及结直肠癌腹腔镜术后短期预后有一定价值。

Objective To evaluate the correlation of the waist circumference and short-term outcomes after laparoscopic surgery in patients with gastric and colorectal cancers.Methods A total of 96 participants with gastrointestinal cancers were enrolled and analyzed retrospectively who had undergo laparoscopic surgery.pa-tients were classified according to waist circumference,which were group A non-central obesity(n=31),group B pre-central obesity(n=43),and group C central obesity(n=22).Clinical characteristics and surgical out-comes were compared among the three groups.Results The prevalence of metabolic syndrome before opera-tion was 9.70%in group A,13.95%in group B,and 36.36%in group C,which was significantly higher than that in group A and group B(P<0.05).The incidence of laparoscopic conversion to open surgery was 0 in group A,7.00%in group B,and 13.60%in group C,which were higher in group C than in group A(P<0.05).The patients whose operation time≥180 min accounted for 41.90%in group A,55.80%in group B,and 77.30%in group C,which were higher in group C than those in group A and group B(P<0.05).The total complication rate of Clavien-Dindo gradeⅡand above was 22.60%in group A,32.60%in group B and 45.50%in group C,which was higher in group C than that in group A(P<0.05).The incidence of infection-related complications was 9.70%in group A,18.60%in group B,and 27.30%in group C,which were higher in group B and group C than that in group A(P<0.05).The hospitalization cost of group C was higher than that of group A(P<0.05).The results of univariate analysis showed preoperative combination of metabolic syndrome,waist circumference,and nutritional risk scores,which were associated with postoperative compli-cations(P<0.05).The results of multivariate analysis showed that the preoperative combination of metabolic syndrome(P=0.002),central obesity(P=0.004)and nutritional risk score≥3(P=0.004)were risk factors of postoperative complications.Conclusion Laparoscopic operation for gastric and colorectal cancers have an increased risk on postoperative complications in abnominal obese patients.Waist circumference is a valuable predictor on the short-term outcomes of laparoscopic operation for gastric and colorectal cancers.