引用本文:程煌荣,黎华丽,黄晓东,杨玉杰,杨 超,郑勇斌.内脏肥胖对结直肠癌根治手术操作及患者预后影响的关联性分析[J].中国临床新医学,2020,13(4):349-354.
【打印本页】   【下载PDF全文】   查看/发表评论  【EndNote】   【RefMan】   【BibTex】
←前一篇|后一篇→ 过刊浏览    高级检索
本文已被:浏览 81次   下载 137 本文二维码信息
码上扫一扫!
分享到: 微信 更多
内脏肥胖对结直肠癌根治手术操作及患者预后影响的关联性分析
程煌荣,黎华丽,黄晓东,杨玉杰,杨 超,郑勇斌
430060 湖北,武汉大学人民医院胃肠外1科
摘要:
[摘要] 目的 分析内脏肥胖对腹腔镜结直肠癌根治手术操作及患者预后影响的关联性。方法 选择该院2012-02~2013-10接受腹腔镜结直肠癌根治手术的结直肠癌患者103例,根据SMA角大小将研究对象分为内脏肥胖组(SMA角≥51.75°,n=52)和非内脏肥胖组(SMA角<51.75°,n=51)。分析内脏肥胖与结直肠癌根治术手术时间、术中出血量、中转开腹率、淋巴结转移率、术后住院时间、术后并发症及术后生存时间之间的关联性。结果 SMA角可用于诊断内脏肥胖,其ROC曲线下面积为0.771(95%CI:0.680~0.863,P<0.05),截断值为51.75°,灵敏度为75.00%,特异度为74.50%。内脏肥胖组男性、年龄≥60岁的人数比例大于非内脏肥胖组,而淋巴结转移率≥18%的人数比例小于非内脏肥胖组,差异有统计学意义(P<0.05)。内脏肥胖组的手术时间长于非内脏肥胖组,中转开腹率高于非内脏肥胖组,差异有统计学意义(P<0.05)。内脏肥胖组的并发症发生率高于非内脏肥胖组(P<0.05),但两组Clavien-Dindo分级情况差异无统计学意义(P>0.05)。内脏肥胖组的术后住院时间长于非内脏肥胖组,差异有统计学意义(P<0.05)。内脏肥胖组的中位生存期(OS)为40个月,非内脏肥胖组的中位OS为38个月,两组OS差异有统计学意义(P<0.05)。单因素分析结果显示,年龄、淋巴结转移、TNM分期和肿瘤分化程度与结直肠癌患者的OS具有关联性(P<0.05)。Cox回归分析结果显示,TNM分期=Ⅲ,肿瘤高、中分化程度和内脏肥胖是结直肠癌根治术后OS的保护因素,而有淋巴结转移为危险因素。结论 SMA角可作为内脏肥胖的诊断指标,且当SMA角为51.75°时诊断效能最大。同时,内脏肥胖会影响结直肠癌手术操作,增加术后并发症发生率,但可改善患者远期预后,延长患者生存时间。
关键词:  结直肠癌  内脏肥胖  预后
DOI:10.3969/j.issn.1674-3806.2020.04.07
分类号:R 735.3
基金项目:吴阶平医学基金会资助课题(编号:320.2710.1855)
Correlative analysis of the effects of visceral obesity on radical operation and prognosis of colorectal cancer
CHENG Huang-rong, LI Hua-li, HUANG Xiao-dong, et al.
The First Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Hubei 430060, China
Abstract:
[Abstract] Objective To analyze the relationship between visceral obesity and the effects of laparoscopic colorectal cancer radical operation and the patients′ prognosis. Methods One hundred and three patients with colorectal cancer who underwent radical laparoscopic colorectal cancer surgery in our hospital between February 2012 and October 2013 were selected. The research subjects were divided into the visceral obesity group(SMA angle ≥51.75°, n=52) and the non-visceral obesity group(SMA angle <51.75°, n=51) according to different SMA angles. The correlation between visceral obesity and the operation time, intraoperative blood loss, rate of converting to laparotomy, lymph node metastasis rate, postoperative hospital stay, postoperative complications and postoperative survival time was analyzed. Results The SMA angle could be used to diagnose visceral obesity. The area under the receiver operating characteristic(ROC) curve was 0.771(95%CI: 0.680~0.863, P<0.05), and the cutoff value was 51.75°. The sensitivity was 75.00% and the specificity was 74.50%. The proportion of males aged ≥60 years old in the visceral obesity group was higher than that in the non-visceral obesity group, and the proportion of the patients with lymph node metastasis rate ≥18% in the visceral obesity group was significantly lower than that in the non-visceral obesity group(P<0.05). The operation time of the visceral obesity group was longer than that of the non-visceral obesity group, and the rate of converting to laparotomy was higher than that of the non-visceral obesity group, and the differences were statistically significant(P<0.05). The complication rate was higher in the visceral obesity group than that in the non-visceral obesity group(P<0.05), but there was no significant difference in Clavien-Dindo classification between the two groups(P>0.05). The length of postoperative hospital stay in the visceral obesity group was longer than that in the non-visceral obesity group, and the difference was statistically significant(P<0.05). The median overall survival(OS) of the visceral obesity group was 40 months, and the median OS of the non-visceral obesity group was 38 months. There was a statistically significant difference in the median OS between the two groups(P<0.05). Univariate analysis showed that age, lymph node metastasis, TNM stage, and tumor differentiation were related to OS in the patients with colorectal cancer(P<0.05). Cox regression analysis showed that TNM stage=Ⅲ, high and moderate differentiation of the tumors and visceral obesity were the protective factors of OS after radical resection of colorectal cancer, and lymph node metastasis was a risk factor. Conclusion SMA angle can be used as a diagnostic indicator of visceral obesity, and the diagnostic efficiency is the highest when the SMA angle is 51.75°. At the same time, visceral obesity can affect the operation of colorectal cancer and increase the incidence of postoperative complications, but it can improve the long-term prognosis and prolong the survival time of the patients.
Key words:  Colorectal cancer  Visceral obesity  Prognosis