内脏肥胖对机器人直肠癌根治术后近期疗效的影响

张雪涛 李亮 杨仁意 孟永康 孙佳豪 杜书祥 赵英志 徐冬利 张伟 吴刚

张雪涛, 李亮, 杨仁意, 孟永康, 孙佳豪, 杜书祥, 赵英志, 徐冬利, 张伟, 吴刚. 内脏肥胖对机器人直肠癌根治术后近期疗效的影响[J]. 中国肿瘤临床, 2023, 50(22): 1153-1158. doi: 10.12354/j.issn.1000-8179.2023.20231074
引用本文: 张雪涛, 李亮, 杨仁意, 孟永康, 孙佳豪, 杜书祥, 赵英志, 徐冬利, 张伟, 吴刚. 内脏肥胖对机器人直肠癌根治术后近期疗效的影响[J]. 中国肿瘤临床, 2023, 50(22): 1153-1158. doi: 10.12354/j.issn.1000-8179.2023.20231074
Xuetao Zhang, Liang Li, Renyi Yang, Yongkang Meng, Jiahao Sun, Shuxiang Du, Yingzhi Zhao, Dongli Xu, Wei Zhang, Gang Wu. Effect of visceral obesity on the short-term outcomes following robotic-assisted radical resection of rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(22): 1153-1158. doi: 10.12354/j.issn.1000-8179.2023.20231074
Citation: Xuetao Zhang, Liang Li, Renyi Yang, Yongkang Meng, Jiahao Sun, Shuxiang Du, Yingzhi Zhao, Dongli Xu, Wei Zhang, Gang Wu. Effect of visceral obesity on the short-term outcomes following robotic-assisted radical resection of rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(22): 1153-1158. doi: 10.12354/j.issn.1000-8179.2023.20231074

内脏肥胖对机器人直肠癌根治术后近期疗效的影响

doi: 10.12354/j.issn.1000-8179.2023.20231074
基金项目: 本文课题受河南省医学科技攻关计划项目(编号:SBGJ202102028)资助
详细信息
    作者简介:

    张雪涛:专业方向为胃肠道肿瘤及减重代谢外科手术治疗

    通讯作者:

    张伟 zzuzwys@163.com

Effect of visceral obesity on the short-term outcomes following robotic-assisted radical resection of rectal cancer

Funds: This work was supported by the Medical Science and Technology Research Project of Henan Province (No. SBGJ202102028)
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  • 摘要:   目的  探讨内脏肥胖对达芬奇机器人直肠癌根治术近期疗效的影响。  方法  回顾性分析2019年11月至2022年6月郑州大学人民医院和郑州大学肿瘤医院收治169例行达芬奇机器人手术的直肠癌患者的临床及病理资料,以内脏脂肪面积≥100 cm2作为定义内脏肥胖的标准,将患者分为内脏肥胖组和非内脏肥胖组,评价两组的近期疗效,应用单因素和多因素Logistic回归分析术后并发症的影响因素。  结果   纳入169例患者中,内脏肥胖组93例,非内脏肥胖组76例,两组基线资料比较差异均无统计学意义(均P>0.05)。非内脏肥胖组无中转开腹病例,内脏肥胖组中转开腹率为1.1%(1/93);内脏肥胖组二次手术率为2.2%(2/93),非内脏肥胖组二次手术率为1.3%(1/76),两组比较差异均无统计学意义(均P>0.05)。两组手术时间、术中出血量、淋巴结清扫数目和术后总并发症发生率比较差异均无统计学意义(均P>0.05),多因素Logistic回归分析提示营养风险筛查2002(NRS2002)评分≥3分是术后并发症的独立危险因素(OR=3.190,95% CI:1.240~8.210;P=0.016)。  结论  NRS2002评分≥3分是机器人直肠癌根治术后并发症的独立危险因素,机器人手术平台可以克服肥胖相关限制,对于内脏肥胖型直肠癌患者同样安全、有效。

     

  • 表  1  两组患者基线资料比较

    基线资料 内脏肥胖组(n=93) 非内脏肥胖组(n=76) χ2 P
    性别 2.697 0.101
     男 64(68.8) 43(56.6)
     女 29(31.2) 33(43.4)
    ASA分级(级) 1.115 0.573
     Ⅰ 10(10.8) 10(13.2)
     Ⅱ 64(68.8) 55(72.3)
     Ⅲ 19(20.4) 11(14.5)
    NRS2002评分(分) 2.010 0.156
     ≥3 11(11.8) 15(19.7)
     <3 82(88.2) 61(80.3)
    肿瘤下缘距肛缘距离(cm) 0.472 0.790
     ≤5 31(33.3) 27(35.5)
     >5~10 49(52.7) 41(54.0)
     >10 13(14.0) 8(10.5)
    病理分期(期) 0.738 0.864
     (y)pT0N0M0 6(6.4) 6(7.9)
     (y)pT1~2N0M0 28(30.1) 21(27.6)
     (y)pT3-4N0M0 33(35.5) 24(31.6)
     (y)pT1~4N1~2M0 26(28.0) 25(32.9)
    手术方式 0.050 0.824
     Dixon术 83(89.2) 67(88.2)
     Mile术 10(10.8) 9(11.8)    
    ( )内单位为%
    下载: 导出CSV

    表  2  两组患者的围手术期指标比较

    观察指标 内脏肥胖组(n=93) 非内脏肥胖组(n=76) t P
    手术时间(min) 222.2±47.3 216.5±48.2 0.764 0.446
    术中出血量(mL) 86.2±51.0 77.4±50.2 1.133 0.259
    中转开腹[例(%)] 1(1.1) 0 1.000a
    二次手术[例(%)] 2(2.2) 1(1.3) 1.000a
    淋巴结清扫数目(枚) 13.4±5.5 15.2±7.6 −1.779 0.077
    a:采用Fisher确切概率法;—:无数据
    下载: 导出CSV

    表  3  两组患者并发症比较

    观察指标内脏肥胖组(n=93)非内脏肥胖组(n=76)χ2P
    总并发症17(18.3)13(17.1)0.0400.842
    吻合口漏4(4.3)3(3.9)1.000a
    出血2(2.2)1(1.3)1.000a
    肠梗阻1(1.1)2(2.6)0.589a
    尿潴留2(2.2)2(2.6)1.000a
    切口脂肪液化或感染4(4.3)1(1.3)0.380a
    肺部感染2(2.2)2(2.6)1.000a
    下肢静脉血栓形成1(1.1)1(1.3)1.000a
    乳糜漏1(1.1)1(1.3)1.000a
    ( )内单位为%;a:采用Fisher确切概率法;—:无数据
    下载: 导出CSV

    表  4  术后并发症发生的单因素和多因素Logistic回归分析

    因素 单因素分析 多因素分析
    OR 95%CI P OR 95%CI P
    年龄(<65岁 vs. ≥65岁) 0.712 0.319~1.587 0.406
    性别(男 vs. 女) 1.438 0.613~3.373 0.404
    内脏肥胖(是 vs. 否) 1.084 0.489~2.402 0.842
    BMI(<25 kg/m2 vs. ≥25 kg/m2 1.064 0.470~2.411 0.881
    合并症(有 vs. 无) 0.846 0.382~1.873 0.680
    既往腹部手术(有 vs. 无) 0.532 0.149~1.898 0.331
    新辅助放化疗(有 vs. 无) 0.655 0.279~1.534 0.329
    NRS2002(≥3分 vs. <3分) 3.076 1.212~7.805 0.018 3.190 1.240~8.210 0.016
    ASA(级) 0.901
     Ⅰ vs. 0.706 0.155~3.224 0.653
     Ⅱ vs. 0.857 0.312~2.356 0.765
    肿瘤下缘距肛缘距离(cm) 0.860
     ≤5 vs. >10 0.781 0.213~2.866 0.709
     >5~10 vs. >10 0.990 0.295~3.320 0.987
    肿瘤大小(<5cm vs. ≥5cm) 0.574 0.228~1.442 0.237
    肿瘤分期(0/Ⅰ期 vs. Ⅱ/Ⅲ期) 1.224 0.545~2.750 0.624
    手术方式(Miles术 vs. Dixon术) 1.786 0.590~5.406 0.305
    造口(是 vs. 否) 0.782 0.355~1.724 0.542
    手术时间(<210 min vs. ≥210 min) 1.550 0.702~3.422 0.279
    术中出血量(<200 mL vs. ≥200 mL) 0.346 0.107~1.120 0.077 0.325 0.098~1.083 0.067
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-10-27
  • 录用日期:  2023-12-06
  • 修回日期:  2023-12-03

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