胃癌患者身体质量指数对腹腔镜术式选择及效果的影响

目的:探讨不同身体质量指数（BMI）对胃癌患者腹腔镜术式选择及疗效的影响。方法:选择行腹腔镜胃癌根治术患者115例，根据患者BMI分为体型肥胖组（BMI>25 kg/m2，35例）和正常组（BMI 18.5~25.0 kg/m2，45例）、低体质量组（BMI<18.5 kg/m2，35例），其中肥胖组患者行腹腔镜辅助远端胃大部切除术（LADG）15例，近端胃大部切除术（LAPG）10例，全胃切除术（LATG）10例；正常组患者采用LADG术14例，LAPG术20例，LATG术11例；低体质量组采用LADG术10例，LAPG术15例，LATG术10例。观察3组患者的术后恢复效果及术后生存情况。结果:肥胖组手术时间较正常组、低体质量组明显延长，术中出血量较正常组、低体质量组增加，淋巴结清扫总数较正常组、低体质量组减少，差异均有统计学意义（P<0.05）。肥胖组术后住院时间较正常组、低体质量组显著延长（P<0.05）。正常组、低体质量组手术时间、术中出血量、淋巴结清扫总数、术后住院时间对比差异无统计学意义（P>0.05）。3组肿瘤直径、术后肛门首次排气时间和术后并发症总发生率差异无统计学意义（P>0.05）。3组患者总生存率和无进展生存率差异均无统计学意义（P>0.05）。结论:不同BMI胃癌患者行腹腔镜辅助LADG、LAPG和LATG根治术治疗，其中体型肥胖组患者较正常组、低体质量组手术时间长，术后恢复时间长，但并不影响术后并发症和预后。

Effects of body mass index on the selection and efficacy of laparoscopic surgery in patients with gastric cancer

Objective To investigate the effects of the body mass indexes(BMI) of patients with gastric cancer on the selection and therapeutic effect of laparoscopic operation. Methods A total of 115 patients receiving laparoscopic radical gastrectomy were enrolled in the study. According to BMI, the patients were divided into 3 groups, namely obese group(BMI>25 kg/m^2, n=35), normal group(BMI 18.5-25.0 kg/m^2, n=45) and underweight group(BMI<18.5 kg/m^2, n=35). There were 15 cases of laparoscopy-assisted distal gastrictomy(LADG), 10 cases of laparoscopy-assisted proximal gastrictomy(LAPG) and 10 cases of laparoscopy-assisted total gastrectomy(LATG) in obese group, 14 cases of LADG, 20 cases of LAPG and 11 cases of LATG in normal group, and 10 cases of LADG, 15 cases of LAPG and 10 cases of LATG in underweight group. The postoperative recovery and postoperative survival in 3 groups were analyzed. Results Compared with those in normal group and underweight group, the operative time in obese group was significantly longer, and the intraoperative blood loss was increased, and the total number of dissected lymph nodes was decreased, with statistical differences(P<0.05). Moreover, the length of postoperative hospital stay in obese group was significantly longer than that in normal group and underweight group(P<0.05). No statistical difference was found in operative time, intraoperative blood loss, the total number of dissected lymph nodes and postoperative hospital stay between normal group and underweight group(P>0.05). Moreover, there were no statistically significant differences among 3 groups in tumor diameter,postoperative first anal exhaust time and the overall incidence of postoperative complications, overall survival rate and progressionfree survival rate(P>0.05). Conclusion Among the gastric cancer patients with different BMI who were treated with LADG, LAPG and LATG, the patients in obese group has longer operative time and postoperative recovery time than those in normal group and underweight group, but BMI has trivial effects on postoperative complications and prognosis.