高体质指数对胸腹腔镜下食管癌根治术后早期并发症的影响

Influence of high body mass index on early complications after thoracoscopy and laparoscopy assisted radical surgery of esophageal carcinoma

摘要:

目的：探讨高体质指数（body mass index，BMI）对胸腹腔镜下食管癌根治术患者术后早期并发症的影响。方法：回顾性分析重庆医科大学附属第一医院胸心外科2014年7至2017年7月期间施行胸腹腔镜下食管癌根治术的186例患者的临床资料。排除术前曾接受过辅助放化疗、合并有心肺基础疾病及糖尿病、术前低白蛋白血症（白蛋白＜35 g/L）、轻BMI（BMI＜18.5 kg/m2）、肺功能损害（FEV1/FVC＜70%）的患者。最终139例患者入组本研究，并根据BMI值分为正常BMI组（18.5 kg/m2≤BMI＜24 kg/m2，96例）和高BMI组（BMI≥24 kg/m2，43例）。统计分析比较2组患者手术时间及术后早期并发症的发生率。结果：2组患者在手术时间上并无统计学差异（t=-1.910，P=0.0583），高BMI组术后切口感染发生率高于正常BMI组，差异有统计学意义（22.86% vs. 7.87%， χ2=3.948，P＜0.05）。但2组间肺部并发症、吻合口瘘、心脏并发症及乳糜胸的发生率比较，差异均无统计学意义（χ2=0.026， χ2=0.033， χ2=0.598， χ2=0.008，均P＞0.05）。结论：高BMI患者胸腹腔镜下食管癌术后较正常BMI患者更易发生切口感染，而术后严重并发症的发生率2组无统计学差异。

Abstract:

Objective：To investigate the influence of high body mass index（BMI） on early complications after thoracoscopy and la－paroscopy assisted radical surgery of esophageal carcinoma. Methods：The clinical data of 186 patients with esophageal cancer under－going the thoracoscopy and laparoscopy assisted radical surgery between July 2014 and July 2017 in Department of Cardiothoracic Surgery，First Affiliated Hospital of Chongqing Medical University were collected and retrospectively analyzed. Patients with preopera－tive adjuvant radio-chemotherapy treatment，basic cardiopulmonary diseases and diabetes，hypoalbuminema（albumin<35 g/L），low BMI（BMI＜18.5 kg/m2） and poor pulmonary function（FEV1/FVC<70%） were excluded. Finally 139 patients met the eligibility crite－ria. The 139 patients were divided into normal BMI group（18.5 kg/m2≤BMI＜24 kg/m2，n=96） and high BMI group（BMI≥24 kg/m2，n=43）. Then the operation time and the prevalence of postoperative complications were compared. Results：There was no statistical difference in the operation time between the two groups（t=-1.910，P=0.0583）.The prevalence of incision infection in high BMI group was significantly higher than that of normal BMI group（22.86% vs. 7.87%， χ2=3.948，P<0.05）. However no significant difference was found between these 2 groups in the incidence rates of anastomotic leakage，pulmonary complications，cardiac complications and chy－lothorax（ χ2=0.026， χ2=0.033， χ2=0.598， χ2=0.008，P>0.05 for all）. Conclusion：Patients with higher BMI are more likely to have inci－sion infection.