肥胖体型对腹腔镜胃癌根治术术后恢复效果和预后的影响
摘要
目的研究肥胖体型对腹腔镜胃癌根治术患者术后恢复效果和预后的影响。方法回顾性分析本院90例腹腔镜胃癌根治术患者临床病历资料,根据体重指数(BMI)分为观察组(体型肥胖者,BMI≥25 kg/m2,36例)和对照组(非肥胖者,BMI <25 kg/m2,54例)。比较两组手术基本情况、术后恢复效果及术后3年生存情况。结果两组胃癌患者肿瘤直径和淋巴结阳性数差异无统计学意义(P> 0.05),观察组手术时间较对照组显著延长,淋巴结清扫总数和术中出血量较对照组减少,差异均有统计学意义(P <0.05)。观察组术后住院时间较对照组显著缩短,差异有统计学意义(P <0.05),两组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)。观察组术后3年肿瘤进展11例,无进展生存率为69.44%(25/36),其中死亡8例,总生存率为77.78%(28/36)。对照组肿瘤进展19例,无进展生存率率为64. 81%(35/54),其中死亡11例,总生存率率为79.63%(43/54)。两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)。结论体型肥胖的腹腔镜胃癌根治术患者手术时间长,术后恢复时间较非肥胖患者显著延长,但并不影响术后并发症和预后。
引文
[1]蒋笃均,张跃,孟闯.比较分析开腹胃癌根治术与腹腔镜胃癌根治术治疗老年胃癌的疗效[J].中国医药科学,2018,8(7):243-246.
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[11] Jiaqing G,Yongkuan C,Yonghua W,et al. Three-step Hand assisted laparo-scopic D2 radical gastrectomy for chinese obese patients:a highly efficient and feasible surgical approach[J]. J Cancer,2015,6(2):120-127.
[12]蘧勐,周群燕.快速康复理念对腹腔镜胃癌根治术后疼痛、炎性反应和胃肠功能的影响[J].中国医药导报,2016,13(17):97-100.
[13]Vivien Choo. WHO reassesses appropriate body-mass index for Asian populations[J]. Lancet,2002,360(9328):235.
[14]Kawaguchi T,Komatsu S,Ichikawa D,et al. Prognostic Influence of the Extent of Lymph Node Dissection and Perioperative Comorbidities in Patients with Gastric Cancer[J]. Anticancer Res,?2016,36(4):1917-1922.
[15]林琳,许庆文,徐飞鹏,等.腹腔镜与开腹全胃切除术联合D2淋巴结清扫在中上部进展期胃癌中的分子学疗效及预后分析[J].癌症进展,2018,16(1):77-83.
[16]Toru K,Norio S,Hidefumi S,et al. Poor prognosis of advanced gastric cancer with metastatic suprapancreatic lymph nodes[J]. Ann Surg Oncol,2013,20(7):2290-2295.
[17]王力,宋国栋,李盟,等.患者术前BMI与胃癌临床病理参数、手术并发症及预后的关系[J].山东医药,2016,56(31):75-77.
[18]宋书彬,李森,薛英威.胃癌患者腹腔冲洗脱落细胞与淋巴结转移的关系[J].中华普通外科杂志,2016,31(4):319-321.
[2] Okabe H,Tsunoda S,Obama K,et al. Feasibility of Laparoscopic Radical Gastrectomy for Gastric Cancer of Clinical Stage II or Higher:Early Outcomes in a Phase II Study(KUGC04)[J]. Ann Surg Oncol,2016,23(4):516-523.
[3]黄昌明,陆俊.腹腔镜胃癌根治术规范化实施值得关注的问题[J].中国实用外科杂志,2014,34(7):616-619.
[4]高子辰,高华,许新才,等.腹腔镜与开腹根治术治疗维吾尔族肥胖胃癌患者的临床疗效对比[J].中华胃肠外科杂志,2016,19(2):221-222.
[5] Cuccurullo V,Mansi L. AJCC cancer staging handbook:from the A JCC cancer stanging manual(7th edition)[J]. Eur J Nucl Med Mol l,2011,38(2):408-408.
[6]刘宁,陈一明,吕云福,等.腹腔镜胃癌根治术治疗肥胖胃癌患者的近期疗效评价[J].海南医学,2016,27(14):2280-2282.
[7] Takcuchi D,Koide N,Komatsu D,et al. Relationships of obesity and diabetes mellitus to other primary cancers in surgically treated gastric cancer patients[J]. Int J Surg,2014,12(6):587-593.
[8]柯昌松.腹腔镜下胃癌根治术对早期胃癌的近远期疗效及并发症的影响研究[J].现代消化及介入诊疗,2015,20(3):264-265.
[9]胡云辉,任统伟,杨银成.肥胖胃癌患者采用腹腔镜胃癌根治术治疗的观察与探讨[J].航空航天医学杂志,2017,28(4):427-428.
[10]刘茂兴,邢加迪.肥胖对腹腔镜辅助胃癌根治术临床疗效的影响[J].临床与病理杂志,2015,35(1):70-71.
[11] Jiaqing G,Yongkuan C,Yonghua W,et al. Three-step Hand assisted laparo-scopic D2 radical gastrectomy for chinese obese patients:a highly efficient and feasible surgical approach[J]. J Cancer,2015,6(2):120-127.
[12]蘧勐,周群燕.快速康复理念对腹腔镜胃癌根治术后疼痛、炎性反应和胃肠功能的影响[J].中国医药导报,2016,13(17):97-100.
[13]Vivien Choo. WHO reassesses appropriate body-mass index for Asian populations[J]. Lancet,2002,360(9328):235.
[14]Kawaguchi T,Komatsu S,Ichikawa D,et al. Prognostic Influence of the Extent of Lymph Node Dissection and Perioperative Comorbidities in Patients with Gastric Cancer[J]. Anticancer Res,?2016,36(4):1917-1922.
[15]林琳,许庆文,徐飞鹏,等.腹腔镜与开腹全胃切除术联合D2淋巴结清扫在中上部进展期胃癌中的分子学疗效及预后分析[J].癌症进展,2018,16(1):77-83.
[16]Toru K,Norio S,Hidefumi S,et al. Poor prognosis of advanced gastric cancer with metastatic suprapancreatic lymph nodes[J]. Ann Surg Oncol,2013,20(7):2290-2295.
[17]王力,宋国栋,李盟,等.患者术前BMI与胃癌临床病理参数、手术并发症及预后的关系[J].山东医药,2016,56(31):75-77.
[18]宋书彬,李森,薛英威.胃癌患者腹腔冲洗脱落细胞与淋巴结转移的关系[J].中华普通外科杂志,2016,31(4):319-321.