体重指数对开腹胰十二指肠切除术患者术后并发症的影响

Impact of body mass index on postoperative complications of open pancreaticoduodenectomy

目的探讨体重指数(BMI)对开腹胰十二指肠切除术(OPD)患者术后并发症的影响。方法回顾性分析2015年1月至2016年6月间海军军医大学第一附属医院肝胆胰外科234例行OPD患者的术前、术中及术后资料,根据BMI亚洲标准,将患者分为偏瘦组(BMI<18.5 kg/m^(2),32例)、正常体重组(18.5 kg/m^(2)≤BMI<23.0 kg/m^(2),110例)和超重组(BMI≥23.0 kg/m^(2),92例),正常体重组分别与偏瘦组和超重组进行两两比较,分析BMI与OPD术中参数及术后主要并发症的相关性。结果偏瘦组患者的糖尿病发生率低于正常体重组,ASA评分为3分的占比高于正常体重组,差异有统计学意义(P<0.05),偏瘦组和正常体重组、超重组和正常体重组的其余术前指标差异均无统计学意义。偏瘦组和正常体重组的手术时间、术中出血量(≥800 ml)和术中输血率差异均无统计学意义,但超重组术中输血率显著高于正常体重组,差异有统计学意义(P<0.05)。和正常体重组比较,偏瘦组的术后腹腔出血率和术后输血率均显著增加,但术后再次入院次数显著减少;超重组的临床相关胰瘘、术后感染、术后消化道出血、术后胃排空延迟发生率均显著高于正常体重组,差异均有统计学意义(P值均<0.05)。偏瘦组、正常体重组、超重组患者OPD术后平均住院天数分别为9.9、11.3、15.0 d,总住院费用分别为6.3663、6.6242、8.0483万元。结论与正常体重患者相比,偏瘦患者不增加OPD的手术难度,而超重患者的OPD手术难度增加;消瘦和超重都会在一定程度上增加OPD术后并发症的发生。

ObjectiveTo investigate the impact of body mass index(BMI)on the postoperative complications of open pancreaticoduodenectomy(OPD).MethodsThe preoperative,operative and postoperative data of 234 patients who underwent OPD in the Department of the Hepatobiliary and Pancreatic Surgery of First Affiliated Hospital affiliated to Naval Medical University from January 2015 to June 2016 were analyzed retrospectively.According to the Asian BMI standard,the patients were divided into three groups:underweight group(BMI<18.5 kg/m^(2),n=32),normal weight group(18.5 kg/m^(2)≤BMI<23.0 kg/m^(2),n=110)and overweight group(BMI≥23.0 kg/m^(2),n=92).Normal weight group was compared with underweight group and overweight group,respectively,to analyze the relationship between BMI and intraoperative parameters and major postoperative complications of OPD.ResultsThe incidence of diabetes in underweight group was lower than that in normal weight group,and the proportion of ASA score 3 in underweight group was higher than that in normal weight group,and there were significantly statistical differences(both P value<0.05).There was no significant difference on the other variables between underweight group,normal weight group and overweight group.The operation time,intraoperative hemorrhage volume>800 ml and intraoperative blood transfusion rate were not statistically different between underweight group and normal weight group,but overweight group had obviously higher intraoperative blood transfusion rate than normal weight group and the difference was statistically significant(P<0.05).Underweight group had more postoperative intraperitoneal hemorrhage and postoperative blood transfusion rate than normal weight group,and the readmission rate in underweight group was less than that in normal weight group;the incidence of clinically related-post operative pancreatic fistula,postoperative infection,gastrointestinal bleeding and delayed gastric emptying in overweight group were significantly higher than those in normal weight group,and there were significantly statistical differences(all P value<0.05).In underweight group,normal weight group and overweight group,the average length of hospital stay were 9.9 days,11.3 days,15 days,and the total hospitalization expenses were 63663.04 yuan,66241.78 yuan and 80484.31 yuan,respectively.ConclusionsCompared to normal weight patients,the difficulty of OPD in underweight patients does not increase,while the difficulty of OPD in overweight patients increases.Underweight and overweight could both increase the postoperative complications of OPD to some extent.