CAJ | 학술논문

目的探讨直肠癌患者体质指数增加对腹腔镜直肠癌手术的可行性、安全性以及生存结果的影响.方法回顾性分析2008年6月至2012年6月新疆医科大学附属肿瘤医院收治的405例腹腔镜直肠癌手术治疗患者的临床资料,根据2007年《中国肥胖病外科治疗指南》的标准将患者分为3组:正常体重组(体质指数18.6 ～22.9kg/m2)165例,超重组(体质指数23.0～ 24.9kg/m2)125例,肥胖组(体质指数≥25.0kg/m2)115例.对比分析3组患者的临床资料、术中和术后情况、并发症、淋巴结清扫数目及近期生存情况.x2检验或方差分析进行组间比较.结果正常体重组和超重组的术前合并症发生率少于肥胖组患者[27.9％ (46/165)、30.4％(38/125)比47.0％ (54/115),x2=12.066,P＜0.05].正常体重组、超重组、肥胖组的中转开腹率[9.1％(15例)、10.4％(13例)、12.2％(14例)],并发症发生率[20.6％(34例)、21.6％(27例)、24.3％(28例)],术中出血量[(105±30)、(110±25)、(115 ±45)ml],肛门排气时间[(2.8±1.2)、(2.9±1.1)、(3.1±1.4)d],术后住院时间[(13.7±5.5)、(14.3±7.5)、(14.1±8.5)d]差异均无统计学意义(均P ＞0.05).肥胖组的手术时间长于正常体重组及超重组[(250±35)比(205 ±20)及(210±30)min,F=7.216,P＜0.05].3组平均淋巴结清扫数目差异无统计学意义(P＞0.05).368例(90.9％)患者获得2～40个月随访,中位随访时间为24个月,3组的生存曲线差异无统计学意义(P＞0.05).结论体质指数的增加对直肠癌患者行腹腔镜辅助直肠癌根治术是安全可行的,并能满足肿瘤根治的要求,不影响近期生存结果.
목적 탐토직장암환자체질지수증가대복강경직장암수술적가행성、안전성이급생존결과적영향.방법 회고성분석2008년6월지2012년6월신강의과대학부속종류의원수치적405례복강경직장암수술치료환자적림상자료,근거2007년《중국비반병외과치료지남》적표준장환자분위3조:정상체중조(체질지수18.6 ～22.9kg/m2)165례,초중조(체질지수23.0～ 24.9kg/m2)125례,비반조(체질지수≥25.0kg/m2)115례.대비분석3조환자적림상자료、술중화술후정황、병발증、림파결청소수목급근기생존정황.x2검험혹방차분석진행조간비교.결과 정상체중조화초중조적술전합병증발생솔소우비반조환자[27.9％ (46/165)、30.4％(38/125)비47.0％ (54/115),x2=12.066,P＜0.05].정상체중조、초중조、비반조적중전개복솔[9.1％(15례)、10.4％(13례)、12.2％(14례)],병발증발생솔[20.6％(34례)、21.6％(27례)、24.3％(28례)],술중출혈량[(105±30)、(110±25)、(115 ±45)ml],항문배기시간[(2.8±1.2)、(2.9±1.1)、(3.1±1.4)d],술후주원시간[(13.7±5.5)、(14.3±7.5)、(14.1±8.5)d]차이균무통계학의의(균P ＞0.05).비반조적수술시간장우정상체중조급초중조[(250±35)비(205 ±20)급(210±30)min,F=7.216,P＜0.05].3조평균림파결청소수목차이무통계학의의(P＞0.05).368례(90.9％)환자획득2～40개월수방,중위수방시간위24개월,3조적생존곡선차이무통계학의의(P＞0.05).결론 체질지수적증가대직장암환자행복강경보조직장암근치술시안전가행적,병능만족종류근치적요구,불영향근기생존결과.
Objective To assess the feasibility,the safety and short-term outcomes of laparoscopic radical rectal surgery for rectal cancer patients with increased body mass index (BMI).Methods Retrospectively data reviewes were conducted for 405 consecutive patients undergoing laparoscopic surgery for rectal cancer from June 2008 to June 2012.They were classified as normal-weight (NW,BMI 18.6-22.9kg/m2,n =165),overweight (OW,BMI 23.0-24.9kg/m2,n =125),and obese (OB,BMI ≥25.0kg/m2,n =115)groups according to the categories as proposed by 2007 Chinese Obesity Surgery Treatment Guidelines.The differences of oncologic,intraoperative and postoperative status,postoperative complications,number of resected lymph nodes and short-term survival rates were compared among three groups.The data were analyzed by x2 or Fisher exact test.The Mann-Whitney U test or analysis of variance (one-way ANOVA) was used for parametric comparisons.The survival curve was drawn by Kaplan Meier method and the survivals of 3 groups were by the Log-rank test.Results The comorbidity of patients in the NW and OW groups were less than that in the OB group(27.9％ (46/165)and 30.4％ (38/125)vs 47.0％(54/115),x2 =12.066,P ＜ 0.05).No significant difference existed among the groups in terms of conversion rate (9.1％ (15/165),10.4％ (13/125) and 12.2％ (14/115)),the rate of postoperative complications (20.6％ (34/165),21.6％ (27/125) and 24.3％ (28/115)),intraoperative volume of blood loss ((105 ± 30),(110 ± 25) and (115 ± 45) ml),first flatus ((2.8 ± 1.2),(2.9 ± 1.1) and (3.1 ± 1.4)d),postoperative hospital stays((13.7 ± 5.5),(14.3 ± 7.5) and(14.1 ± 8.5) d,all P ＞ O.05),and the mean number of retrieved lymph nodes (P ＞ 0.05).While the operation duration in the OB group were longer than that in the NW and OW groups ((250 ±35) vs(205 ±20)and(210 ±30)min,F =7.216,P ＜0.05).And 368 patients (90.9％) were followed up for a median of 24 months(2-48 months).As for survival curves,no significant difference existed among three groups (P ＞ 0.05).Conclusions It is both safe and feasible for obese patients with increased BMI to undergo laparoscopic radical rectal cancer.And there is no effect upon immediate survival.