Chen Ke, Pan Yu, Yu Wei-Hua, Zheng Xue-Yong, Zhu Ling-Hua, Wang Xian-Fa
Department of Gastrointestinal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang Province, China.
Surg Laparosc Endosc Percutan Tech. 2018 Feb;28(1):e18-e23. doi: 10.1097/SLE.0000000000000497.
Few studies have compared the surgical outcomes of laparoscopic (LG) and open (OG) gastrectomy in obese patients (BMI≥30 kg/m) with gastric cancer. The current study aimed to investigate the short-term outcomes of LG in this group of patients.
A total of 33 LG cases and 23 OG cases (BMI≥30 kg/m) were identified from our gastric cancer database. Clinicopathologic features, operative details, laboratory examination, and postoperative outcomes were compared between both groups. Regression analysis was used to determine the effects of BMI on intraoperative outcomes.
The 2 groups had comparable clinicopathologic characteristics. LG was associated with significantly lesser blood loss, whereas both also groups had a similar operative time, and number of harvested lymph nodes. However, regression analysis indicated that increased BMI affected the operative time and blood loss in patients that underwent OG but had little effect on patients who received LG. The elevation of inflammatory factors (WBC, CRP) was lower in LG than in OG, postoperatively. Postoperative hepatic (alanine aminotransferase, total bilirubin, albumin) and renal (creatinine, blood urea nitrogen) functions in the LG group were not worse than in the OG group. The time to first flatus, initiation of diet, hospitalization, and postoperative complications seemed superior in LG than in OG, but these differences were not statistically significant.
LG can be safely performed in obese gastric cancer patients. Compared with conventional OG, LG is less invasive and is characterized by less blood loss and milder surgical trauma. LG is also less adversely affected by increased BMI.
很少有研究比较肥胖（BMI≥30kg/m²）胃癌患者行腹腔镜（LG）与开腹（OG）胃切除术的手术效果。本研究旨在调查该组患者行LG的短期效果。
从我们的胃癌数据库中识别出33例行LG的病例和23例行OG的病例（BMI≥30kg/m²）。比较两组的临床病理特征、手术细节、实验室检查及术后效果。采用回归分析确定BMI对术中效果的影响。
两组具有可比的临床病理特征。LG的失血量明显较少，而两组的手术时间和清扫淋巴结数量相似。然而，回归分析表明，BMI增加对行OG的患者的手术时间和失血量有影响，但对行LG的患者影响不大。术后LG组炎症因子（白细胞、C反应蛋白）的升高低于OG组。LG组术后肝脏（谷丙转氨酶、总胆红素、白蛋白）和肾脏（肌酐、血尿素氮）功能不比OG组差。LG组首次排气时间、开始进食时间、住院时间及术后并发症似乎优于OG组，但这些差异无统计学意义。
肥胖胃癌患者行LG手术是安全的。与传统OG相比，LG侵袭性更小，具有失血量少和手术创伤轻的特点。LG受BMI增加的不利影响也较小。
