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中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 34 -39. doi: 10.3877/cma.j.issn.1674-0793.2023.01.007

论著

腹部内脏脂肪面积对直肠癌手术预后评估价值的研究
师帅1, 吴云桦1, 马文星1, 胥博愈1, 陈昕1, 秦豪原1, 刘思达1, 王泽正1, 张金1, 段降龙1,()   
  1. 1. 710068 西安,陕西省人民医院普外二科
  • 收稿日期:2022-06-16 出版日期:2023-02-01
  • 通信作者: 段降龙
  • 基金资助:
    陕西省重点研发计划项目(2019ZDLSF02-09-01); 陕西省科委基金项目(S2021-ZC-TD-0094); 陕西省创新能力支撑计划项目(2019GHJD-14)

Study on the value of abdominal visceral fat area in evaluating the prognosis of patients after rectal cancer surgery

Shuai Shi1, Yunhua Wu1, Wenxing Ma1, Boyu Xu1, Xin Chen1, Haoyuan Qin1, Sida Liu1, Zezheng Wang1, Jin Zhang1, Xianglong Duan1,()   

  1. 1. Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
  • Received:2022-06-16 Published:2023-02-01
  • Corresponding author: Xianglong Duan
引用本文:

师帅, 吴云桦, 马文星, 胥博愈, 陈昕, 秦豪原, 刘思达, 王泽正, 张金, 段降龙. 腹部内脏脂肪面积对直肠癌手术预后评估价值的研究[J/OL]. 中华普通外科学文献(电子版), 2023, 17(01): 34-39.

Shuai Shi, Yunhua Wu, Wenxing Ma, Boyu Xu, Xin Chen, Haoyuan Qin, Sida Liu, Zezheng Wang, Jin Zhang, Xianglong Duan. Study on the value of abdominal visceral fat area in evaluating the prognosis of patients after rectal cancer surgery[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(01): 34-39.

目的

探讨不同腹部内脏脂肪面积(VFA)的直肠癌患者围手术期恢复情况及近远期预后差异。

方法

回顾性分析2016年6月至2019年7月陕西省人民医院161例确诊为直肠癌且行手术治疗的患者资料。收集患者基础资料、病理资料、围手术期恢复指标以及术后随访状况,以CT值(HU)不同标记肌肉组织和脂肪组织,采用Slice-O-Matic软件得到第三腰椎层面VFA。以134.6 cm2(男)和91.1 cm2(女)为界值,对不同VFA组患者进行统计分析。

结果

与低VFA组相比,高VFA组患者手术时间延长[(253.05±70.09)min vs(227.16±93.10)min,t=1.506,P=0.048],术中出血量增加[(284.06±233.43)ml vs(192.84±323.57)ml,t=2.049,P=0.042],术中淋巴结清扫数量减少[(12.84±3.39)个vs(14.78±6.30)个,t=-2.439,P=0.016],术后禁饮食时间延长[(4.76±1.13)d vs(4.25±1.04)d,t=3.012,P=0.003],术后排气时间延长[(4.31±1.35)d vs(3.89±0.94)d,t=2.316,P=0.022],胃管留置时间增加[(3.05±2.06)d vs(2.46±1.18)d,t=2.235,P=0.027],术后住院时间增加[(14.56±6.09)d vs(12.72±5.55)d,t=2.011,P=0.046]。高VFA组患者术后总并发症发生率较低VFA组明显增加(27.5% vs 14.8%,χ2=3.888,P<0.05),累积总生存率(62.4% vs 78.9%)和累积无病生存率(57.5% vs 75.9%)较低VFA组明显降低,差异均有统计学意义(P<0.05)。

结论

腹部VFA对直肠癌手术患者的预后评估具有一定价值,高VFA会增加直肠癌根治术难度,影响患者术后恢复和长期生存,增加患者围手术期并发症的发生风险。

Objective

To assess the perioperative recovery and short- and long-term postoperative outcomes of rectal cancer patients with different abdominal visceral fat area (VFA).

Methods

A total of 161 patients with rectal cancer treated by surgery in Shaanxi Provincial People’s Hospital from June 2016 to July 2019 were retrospectively analyzed. The clinical baseline data, perioperative recovery indicators, follow-up status of the patitents were collected, and the CT values (hounsfield unit, HU) were used to mark muscle tissue and adipose tissue differently. The VFA of the third lumbar vertebra bedding was obtained by Slice-O-Matic software. The patients were classified to high VFA group (≥134.6 cm2 in males and ≥91.1 cm2 in females) and low VFA group (<134.6 cm2 in males and <91.1 cm2 in females).

Results

Compared with the low VFA group, the operation time was prolonged [(253.05±70.09) min vs (227.16±93.10) min, t=1.506, P=0.048], the intraoperative bleeding volume was increased [(284.06±233.43) ml vs (192.84±323.57) ml, t=2.049, P=0.042], the number of lymph node dissections was reduced [(12.84±3.39) vs (14.78±6.30), t=-2.439, P=0.016], the postoperative fasting time was prolonged [(4.76±1.13) d vs (4.25±1.04) d, t=3.012, P=0.003], the postoperative exhaust time was prolonged [(4.31±1.35) d vs (3.89±0.94) d, t=2.316, P=0.022], the gastric tube retention time was increased [(3.05±2.06) d vs (2.46±1.18) d, t=2.235, P=0.027], and the postoperative hospitalization time was increased [(14.56±6.09) d vs (12.72±5.55) d, t=2.011, P=0.046] in the high VFA group. The incidence of postoperative complications in the high VFA group was significantly higher than that in the low VFA group (27.5% vs 14.8%, χ2=3.888, P<0.05). High VFA was identified as significant prognostic factors for poorer cumulative overall survival (62.4% vs 78.9%) and cumulative disease-free survival (57.5% vs 75.9%), and the differences between the two groups were statistically significant (P<0.05).

Conclusions

Abdominal VFA is of certain value in the evaluation of postoperative prognosis of rectal cancer. Elevated abdominal VFA may increase the difficulty of radical resection for rectal cancer, affect the postoperative recovery and long-term survival of patients, and is associated with adverse postoperative outcome.

图1 直肠癌手术患者第三腰椎层面的腹部CT图片 蓝色代表皮下脂肪面积,红色代表腹壁及腰部肌肉面积,绿色代表腹部内脏脂肪面积,灰色代表肠道或其他脏器面积
表1 腹部VFA与直肠癌手术患者一般资料的比较
表2 腹部VFA与直肠癌手术患者病理资料的关系
表3 不同VFA分组患者的围手术期指标比较(±s)
表4 不同VFA患者围手术期并发症发生情况比较[例(%)]
表5 直肠癌根治术患者围手术期并发症发生的单因素和多因素分析
图2 两组直肠癌患者术后累积生存率比较的Kaplan-Meier分析
图3 两组直肠癌患者术后累积无病生存率的Kaplan-Meier分析
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