肥胖对胃癌患者术后短期结局的影响

目的探讨肥胖对胃癌患者手术操作及术后短期结局的影响。方法将2006年1月至2008年6月青岛大学医学院附属医院经手术治疗的胃癌患者426例，按入院时人体质量指数（BMI）分为肥胖组（127例，BMI大于或等于25）与非肥胖组（299例，BMI小于25），予以CT测量脐水平腹部皮下脂肪（SCF）厚度、腹部前后径（APD）和腹部横径（TD），记录手术时间、术中出血量、术后发热天数、术后腹腔引流量、术后并发症发生率、住院死亡率和住院时间及住院费用．并进行统计学分析。结果胃癌患者中肥胖并发率为29．8％。肥胖组和非肥胖组SCF分别为（21．8±7．1）mm和（14．4±7．5）mm；APD分别为（223．2±24．6）mm和（181．8±23．5）mm，TD分别为（323．6±23．8）mm和（285．8±24．4）mm，差异均具有统计学意义（P=0．000）。肥胖组和非肥胖组的手术时间分别为（182．6±100．4）min和（157．1±46．2）min（P=0．007）；淋巴结清扫数目分别为（17．0±9.3）枚和（21．7±10．9）枚（P=0．000）；术后发热时间分别为（3．0±1．4）d和（2．4±1．4）d（P=0．000）：术后并发症发生率分别为22．8％和12．0％（P=0．005）；住院时间分别为（17．4±12．9）d和（15．0±9．0）d（P=0．029）。两组住院死亡率差异无统计学意义（P=0．702）。结论CT扫描可直观显示胃癌患者的腹部形态．有助于判断手术的难度。肥胖可使胃癌手术操作难度和术后并发症发生率增加．影响其术后短期结局。

Influence of obesity on short-term surgical outcome in patients with gastric cancer

Objective To explore the influence of obesity on surgical procedure and short-term surgical outcome in patients with gastric carcinoma. Methods A total of 426 patients with gastric carcinoma underwent laparotomy in our hospital during January 2006 and June 2008. All the patients were divided into obesity group and non-obesity group according to body mass index (BMI). The thickness of subcutaneous fat (SCF), abdominal anteriorposterior diameter (APD) and transverse diameter(TD) at the umbilicus level were measured by abdominal CT. Furthermore, the surgical data and postoperative conditions including short-term outcome were reviewed and compared between two groups. Results The incidence of obesity was 29.8% in gastric carcinoma patients. Mean values of SCF thickness, APD and TD in obesity group and non-obesity group were (21.8±7.1) mm vs (14.4±7.5) mm,(223.2±24.6) mm vs (181.8±23.5) mm and (323.6±23.8) mm vs (285.8±24.4) mm (P=0.000). Longer operative time (P=0.007) and tess amount of dissected lymph nodes were found in obesity group as compared to non-obesity group(P=0.000). Also, obesity group lasted a longer postoperative period of fever (P=0.000) and experienced more post-operative complications (P=0.005) than non-obesity group did.Conclusions Abdominal CT scan may display the abdominal shape of gastric carcinoma patients,hence, it is useful to evaluate the difficulty of surgical procedure. These patients may involve in complicated surgical procedure and worse short-term outcome due to obese abdominal shape. Therefore,perioperative management should be emphasized for these patients.