过量的内脏脂肪是直肠癌术后吻合口漏形成的危险因素:一项配对病例对照研究

目的:探讨内脏脂肪水平与直肠癌术后吻合口漏形成的关联。方法:回顾性分析2014年09月至2021年05月期间在我院行直肠前切除术并发生术后吻合口漏的51例直肠癌患者的临床资料，采用配对病例对照设计，以患者的年龄、肿瘤TNM分期、ASA分级、直肠癌家族史、糖尿病史为筛选因素选取在同期开展、同组医生实施直肠前切除术的102例患者，以样本量1∶2的方式进行配对。比较两组在性别、内脏脂肪面积（visceral fat area,VFA）、内脏脂肪面积/皮下脂肪面积（visceral fat area/subcutaneous fat area，V/S）、体质量指数（body mass index，BMI）、术前有无新辅助放化疗、手术时间、术中出血量、肿瘤直径、肿瘤距肛缘距离等方面的差别。结果:共纳入样本153个，其中吻合口漏组样本51个，对照组样本102个。单因素分析显示直肠癌术后吻合口漏的发生与性别、VFA、V/S、术前新辅助放疗史、术中出血量、肿瘤距肛缘距离及肿瘤直径有关（P＜0.05）。对这些因素进行多因素Logistic回归分析发现VFA、V/S、术前新辅助放疗史、肿瘤距肛缘距离、肿瘤直径及术中出血量是直肠癌术后吻合口漏发生的独立危险因素（P＜0.05）。结论:VFA可作为直肠癌术后吻合口漏的独立危险因素。针对内脏型肥胖的患者，围手术期应积极干预，合理调控基础疾病及营养状况，加强围手术期管理，减少术后吻合口漏的发生。

Excess visceral fat increases the risk of anastomotic leakage after rectal cancer surgery:A paired case-control study

Objective:To investigate the association between visceral fat level and anastomotic leakage formation after rectal cancer surgery.Methods:A retrospective analysis was performed on 51 patients with rectal cancer who underwent anterior rectal resection and developed postoperative anastomotic leakage in our hospital from September 2014 to May 2021.A paired case-control design was used to select 102 patients who underwent anterior rectal resection at the same time and by the same group of surgeons in a sample size of 1∶2,using the patients' age,tumor TNM stage,ASA classification,family history of rectal cancer,and history of diabetes as screening factors.The differences in gender,visceral fat area (VFA),visceral fat area/subcutaneous fat area (V/S),body mass index (BMI),the history of preoperative neoadjuvant chemoradiotherapy,duration of surgery,intraoperative bleeding,tumor diameter,and distance from the anal verge were compared between the two groups.Results:A total of 153 samples were included,including 51 samples from the anastomotic leakage group and 102 samples from the control group.Univariate analysis showed that the occurrence of postoperative anastomotic leakage in rectal cancer was associated with gender,VFA,V/S,history of preoperative neoadjuvant radiotherapy,intraoperative bleeding,distance from the anal verge,tumor diameter (P＜0.05).Multivariate Logistic regression analysis of these factors revealed that VFA,V/S,history of preoperative neoadjuvant radiotherapy,distance from the anal verge,tumor diameter,and intraoperative bleeding were independent risk factors for anastomotic leakage after rectal cancer surgery (P＜0.05).Conclusion:VFA can be an independent risk factor for postoperative anastomotic leakage in rectal cancer.For patients with visceral obesity,active interventions should be made during the perioperative period to reasonably regulate the underlying disease and nutritional status and strengthen perioperative management to reduce the occurrence of postoperative anastomotic leakage.