肥胖患者的腹腔镜辅助胃癌根治术

目的探讨肥胖因素对腹腔镜辅助胃癌根治术近期疗效的影响。方法回顾性分析我科2006年3月-2011年10月412例腹腔镜辅助胃癌根治术的临床资料，其中体重指数（body mass index，BMI）92594例（肥胖组），BMI〈25318例（非肥胖组），比较2组患者术中情况、术后恢复、手术并发症等指标。结果肥胖组手术时间明显长于非肥胖组[（220．7±40．4）min vs．（185．5±29．1）min，t=9．365，P=0．000]，术中出血量明显多于非肥胖组[（132．1±34．1）mlvs．（106．2±18．6）ml，t=9．572，P=0．000]，2组肛门排气时间虽有统计学差异，但无实际临床意义[（3．6±1．0）dVB．（3．4±0．8）d，t=2．005，P=0．046]。肥胖组淋巴结清扫数目为（20．8±7．5）枚，明显少于非肥胖组（27．1±8．7）枚（t=-6．356，P=0．000）。肥胖组与非肥胖组术后并发症发生率分别为19．1％（18／94）和13．2％（42／318），无统计学差异（χ2=2．058，P=0．151）。2组围手术期死亡率分别为2．1％（2／94）和0．3％（1／318），无统计学差异（P=0．132）。结论肥胖会延长腹腔镜辅助胃癌根治术的手术时间，影响淋巴结清扫，但不增加术后并发症发生率，开展初期应选择BMI〈25的非肥胖病例。

Laparoscopic-assisted Radical Gastrectomy for Obese Patients with Gastric Cancer

Objective To study the impact of obesity on the short-term outcome of laparoscopic-assisted radical gastrectomy. Methods A total of 412 patients with gastric cancer, including 94 patients with BMI ≥〉 25 （obese group） and 318 patients with BMI 〈 25 （non-obese group） , underwent radical resection from March 2006 to October 2011. The intraoperative and postoperative indicators and surgical complications were compared between the two groups. Results The obese group had significantly longer operation time, more intraoperative blood loss, and more removed lymph nodes [ （220.7 ± 40.4） rain vs. （ 185.5 ± 29.1 ） min, t = 9. 365, P = 0.000; （132.1±34.1） mlvs. （106.2±18.6） ml, t=9.572, P=0.000; and 27.1 ±8.7 vs. 20.8±7.5, t= -6.356, P= 0. 000; respectively]. No significant difference existed in the postoperative rate of complications and peri-operative mortality [ 19.1% （18/94） vs. 13.2% （42/318） ,χ2 =2.058, P =0. 151; and 2.1% （2/94） vs. 0.3% （1/318）, P =0. 132; respectively ]. There existed statistically significant difference [ （3.6 ±1. 0） d vs. （ 3.4 ± 0.8 ） d, t = 2. 005, P = 0. 046 ], but not clinically significant difference, between the two groups in gastrointestinal function recovery time. Conclusions Obesity is associated with prolonged operation time and affects the number of resected lymph nodes, but it does not increase postoperative complication rate for laparoscopic radical gastrectomy. In hospitals, where the procedure is just adopted, we recommend to start with patients with BMI 〈 25.