CAJ | 학술논문

目的：探讨内脏脂肪面积（VFA）对腹腔镜胃癌根治手术操作及术后临床疗效的影响。方法回顾性分析2011年5月至2014年7月间于青岛大学附属医院普通外科行腹腔镜胃癌根治术的202例患者的临床病理及影像资料。其中CT测得VFA大于10000 mm2者104例（VFA-L组），小于或等于10000 mm2者98例（VFA-S组）。比较两组患者的术中及术后相关指标。结果两组患者手术时间、术中出血量及淋巴结清扫数的差异均无统计学意义（均P＞0．05）；但VFA-L组较VFA-S组患者的中转开腹率明显增加[9．6％（10／104）比2．0％（2／98）， P＝0．023]。与VFA-S组相比，VFA-L组患者术后并发症的发生率增高[22．1％（23／104）比10．2％（10／98）， P＝0．003），术后发热时间延长[（3．0±1．3） d比（2．4±1．1） d， P＝0．000]，总住院时间[（18．6±11．8） d比（15．8±6．0） d， P＝0．039]延长；而两组术后首次排气时间及住院费用差异无统计学意义（均P＞0．05）。结论 VFA增大会增加腹腔镜胃癌根治术的操作难度和术后并发症发生风险并延缓患者的术后恢复。
목적：탐토내장지방면적（VFA）대복강경위암근치수술조작급술후림상료효적영향。방법회고성분석2011년5월지2014년7월간우청도대학부속의원보통외과행복강경위암근치술적202례환자적림상병리급영상자료。기중CT측득VFA대우10000 mm2자104례（VFA-L조），소우혹등우10000 mm2자98례（VFA-S조）。비교량조환자적술중급술후상관지표。결과량조환자수술시간、술중출혈량급림파결청소수적차이균무통계학의의（균P＞0．05）；단VFA-L조교VFA-S조환자적중전개복솔명현증가[9．6％（10／104）비2．0％（2／98）， P＝0．023]。여VFA-S조상비，VFA-L조환자술후병발증적발생솔증고[22．1％（23／104）비10．2％（10／98）， P＝0．003），술후발열시간연장[（3．0±1．3） d비（2．4±1．1） d， P＝0．000]，총주원시간[（18．6±11．8） d비（15．8±6．0） d， P＝0．039]연장；이량조술후수차배기시간급주원비용차이무통계학의의（균P＞0．05）。결론 VFA증대회증가복강경위암근치술적조작난도화술후병발증발생풍험병연완환자적술후회복。
Objective To explore the influence of visceral fat area (VFA) on laparoscopic radical gastrectomy and short-term outcome in patients with gastric carcinoma. Methods Clinicopathological and imaging data of 202 patients with gastric cancer who were treated by laparoscopic radical gastrectomy in the Affiliated Hospital of Qingdao University from May 2011 to July 2014 were retrospectively analyzed. VFA of all the patients were measured by CT , of which more than 10 000 m2 were found in 104 patients (VFA-L group), less than 10 000 m2 in other 98 patients (VFA-S group). Intraoperative and postoperative outcomes were compared between the two groups. Results There were no differences in operation time, intraoperative blood loss and number of harvested lymph node between the two groups (all P>0.05). As compared to VFA-S group, VFA-L group had a higher incidence of conversion to open surgery[9.6%(10/104) vs. 2.0%(2/98), P=0.023], higher complication rate [22.1%(23/104) vs. 10.2%(10/98), P=0.003], longer postoperative fever time [(3.0±1.3) d vs. (2.4±1.1) d, P=0.000], total length of hospital stay[(18.6±11.8) d vs.(15.8±6.0) d, P=0.039]. There were no significant differences in first flatus passage time and total hospitalization costs between the two groups. Conclusion Elevated VFA can raise the difficulty of laparoscopic radical gastrectomy, increase the risk of postoperative complication and prolong the postoperative recovery.