体质量指数对内括约肌切除术治疗直肠癌和肛管癌近期疗效的影响

目的探讨体质量指数（body mass index,BMI）对内括约肌切除术（intersphincteric resection,ISR）治疗直肠癌和肛管癌近期疗效的影响。方法回顾性分析2009年1月至2011年12月期间四川大学华西医院胃肠外科中心结直肠外科专业组收治的199例行ISR术的直肠癌和肛管癌患者的临床资料,按BMI值将其分为消瘦组（n=23）、正常组（n=114）及超重组（n=62）,比较3组患者的临床近期疗效。结果术后早期康复方面,3组患者的首次排气时间、首次排便时间、首次下床活动时间、首次经口进食时间及术后住院时间比较差异均无统计学意义（P〉0.05）。管道管理方面,3组患者拔除引流管时间比较差异有统计学意义,正常组和超重组拔除引流管的时间较长（P〈0.05）,而拔除胃管和尿管时间的差异均无统计学意义（P〉0.05）。3组患者术后并发症（包括吻合口漏、吻合口出血、肛周感染、肠梗阻、胃潴留、尿潴留、败血症、伤口感染及直肠阴道瘘）发生率比较差异均无统计学意义（P〉0.05）。结论 BMI对ISR治疗直肠癌和肛管癌近期疗效的影响较小,肥胖不会提高术后并发症的发生率;在适当管理模式的配合下,也不会影响术后早期康复指标。

Impact of Body Mass Index on Short-Term Outcomes after Intersphincteric Resection for Rectal Cancer and Anal Cancer

Objective To evaluate the impact of body mass index（BMI）on short-term outcomes after intersphincteric resection（ISR）for rectal cancer and anal cancer.Methods One hundred and ninety-nine cases of rectal cancer and anal cancer who were treated in Department of Gastrointestinal Surgery of West China Hospital of Sichuan University from Jan.2009 to Dec.2011 were enrolled retrospectively,and these cases were divided into underweight group（n=23）,normal group（n=114）,and overweight group（n=62）according to BMI.Postoperative indexes in early rehabilitation and complication of 3 groups were studied and compared.Results On the recovery indexes after ISR in early stage,there were no significant differences on the duration of first flatus,first defecation,first oral intake,first ambulation,and hospital stay among 3 groups（P〈0.05）.On the tube management,there were no significant differences on the duration of pulling out nasogastric tube and urinary catheter（P〈0.05）,but duration of pulling out drain was longer in normal group and overweight group（P〈0.05）.There were no significant differences on the incidence of postoperative complications among the 3 groups（P〈0.05）,including anastomotic leakage,anastomotic bleeding,perianal infection,ileus,gastric retention,urinary retention,septicemia,wound infection,and recto-vaginal fistula.Conclusions BMI has little impact on short-term outcomes after ISR.Obesity does not increase the incidence of common complications for patients after ISR and does not influence recovery indexes with proper postoperative managements.