肥胖对腹腔镜辅助胃癌根治术临床疗效的影响

目的探讨肥胖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2007年5月至2010年6月间在福建医科大学附属协和医院接受腹腔镜辅助胃癌根治术的531例患者的临床资料,其中BMI大于或等于25kg／m^2者83例（肥胖组）,小于25kg／m^2者448例（非肥胖组）。比较两组患者术中、术后及近期生存情况。结果肥胖组与非肥胖组患者中转开腹率分别为2．4％（2／83）和1．8％（8／448）,差异无统计学意义（P〉O．05）。除手术时间肥胖组高于非肥胖组外（224．7±57．3）min比（210．0±57．9）min,P〈O．05],两组术中出血量、术中输血率、术后第1天白细胞和中性粒细胞增加数、体温恢复时间、肛门排气时间及术后住院时间的差异均无统计学意义（均P〉0．05）。肥胖组平均淋巴结清扫数目为（24．8±8．4）枚／例,明显少于非肥胖组的（29．9±10．2）枚／例（P〈O．05）。肥胖组与非肥胖组术后并发症发生率分别为16．8％（14／83）和10．2％（46／448）,围手术期死亡率分别为1．2％（1／83）和0．4％（2／448）。3年生存率分别为68．8％和74．0％．差异均无统计学意义（均P〉O．05）。结论肥胖虽然会延长腹腔镜胃癌根治术的手术时间．但并不会影响手术安全性和近期疗效。

Impact of obesity on laparoscopic-assisted radical gastrectomy for gastric cancer

Objective To study the impact of obesity on the short-term outcomes after laparoscopic-assisted radical gastrectomy.Methods A total of 531 gastric cancer patients underwent radical resection at the Fujian Medical University Union Hospital between May 2007 and June 2010.There were 83 patients with BMI≥25 kg/m2(obese group) and 448 patients with BMI＜25 kg/m2 (non-obese group).Intraoperative and postoperative parameters,and short-term survival rates between the two groups were compared.Results There was no significant difference between obese and nonobese patients in terms of conversion rate (2.4％ vs.1.8％,P＞0.05).The operative time in obese group was (224.7±57.3) min,which was significantly longer than that in non-obese group (210.0±57.9) min,P＜0.05].However,no statistically significant differences were observed between obese and non-obese groups in terms of blood loss,blood transfusion rate,elveated leukocyte and granulocyte count on the first postoperative day,time to temperature recovery,fast flatus,and postoperative hospital stays (P＞0.05).The mean number of retrieved lymph nodes in obese group was (24.8±8.4),and was significantly less than that of non-obese group (29.9±10.2),P＜0.05].There were no significant differences between obese and non-obese groups in postoperative complication rate (16.8％vs.10.2％,P＞0.05),postoperative mortality (1.2％ vs.0.4％,P＞0.05),and 3-year overall survival (68.8％ vs.74.0％,P＞0.05).Conclusions Obesity is associated with prolonged operative time for laparoscopic radical gastrectomy.However,the short-term outcomes after the laparoscopic radical gastrectomy is not infiuenced by obesity.