代谢综合征对腹腔镜结肠切除术术后结局的影响。
The effect of metabolic syndrome on postoperative outcomes following laparoscopic colectomy.
机构信息
Department of Digestive Surgery, Avicenne Hospital, Paris XIII University, 125, Rue de Stalingrad, 93000, Bobigny, France.
Laboratory of Medical Ethics and Legal Medicine, Descartes University Paris, Paris, France.
出版信息
Tech Coloproctol. 2018 Mar;22(3):215-221. doi: 10.1007/s10151-018-1772-7. Epub 2018 Mar 14.
BACKGROUND
Among the criteria used to diagnose metabolic syndrome (MS), obesity and diabetes mellitus (DM) are associated with poor postoperative outcomes following colectomy. MS is also associated with colorectal cancer (CRC) and diverticulosis, both of which may be treated with colectomy. However, the effect of MS on postoperative outcomes following laparoscopic colectomy has yet to be clarified.
METHODS
In an academic tertiary hospital, data from all consecutive patients undergoing laparoscopic colectomy from 2005 to 2014 were prospectively recorded and analysed. Patients presenting with MS [defined by the presence of three or more of the following criteria: elevated blood pressure, body mass index > 28 kg/m, dyslipidemia (decreased serum HDL cholesterol, increased serum triglycerides) and increased fasting glucose/DM] were compared with patients without MS regarding peri-operative outcome [mainly anastomotic leaks, severe postoperative complications (Clavien-Dindo III and IV)] and mortality.
RESULTS
Overall, 1236 patients were included: 508 (41.1%) right colectomies and 728 (58.9%) left colectomies. Seven hundred seventy-two (62.4%) of these procedures were performed for CRC. MS was diagnosed in 85 (6.9%) patients, who were significantly older than the others (70 vs. 64.2 years, p < 0.001), and presented with more cardiac comorbidities (p < 0.001). MS was associated with increased blood loss (122.5 vs. 79.9 mL p = 0.001) and blood transfusion requirement (5.9 vs. 1.7%, p = 0.021). The anastomotic leak rate was 6.6% (with 2.2% of anastomotic leaks requiring surgical treatment), and the overall reoperation rate was 6.9%. The incidence of severe postoperative complications was 11.5%, and the overall mortality rate 0.6%. No differences were found between the groups in overall postoperative morbidity and mortality. Median length of stay was similar in both groups (7 days).
CONCLUSIONS
MS does not jeopardize postoperative outcomes following laparoscopic colectomy.
背景
在用于诊断代谢综合征 (MS) 的标准中，肥胖症和糖尿病 (DM) 与结肠切除术的术后不良结局相关。MS 还与结直肠癌 (CRC) 和憩室病相关，这两种疾病都可能需要进行结肠切除术治疗。然而，MS 对腹腔镜结肠切除术的术后结局的影响尚未明确。
方法
在一家学术性的三级医院，前瞻性地记录和分析了 2005 年至 2014 年间所有连续接受腹腔镜结肠切除术的患者的数据。患有 MS 的患者（定义为存在以下三个或更多标准：血压升高、身体质量指数 > 28kg/m2、血脂异常（血清高密度脂蛋白胆固醇降低、血清甘油三酯升高）和空腹血糖升高/糖尿病）与无 MS 的患者进行围手术期结局（主要是吻合口漏、严重术后并发症（Clavien-Dindo III 和 IV 级））和死亡率的比较。
结果
总共纳入了 1236 名患者：508 名（41.1%）接受右半结肠切除术，728 名（58.9%）接受左半结肠切除术。这些手术中有 772 例（62.4%）是为 CRC 进行的。85 名（6.9%）患者被诊断为 MS，他们明显比其他患者年龄更大（70 岁比 64.2 岁，p < 0.001），且伴有更多的心脏合并症（p < 0.001）。MS 与出血量增加（122.5 毫升比 79.9 毫升，p = 0.001）和输血需求（5.9%比 1.7%，p = 0.021）相关。吻合口漏的发生率为 6.6%（2.2%需要手术治疗的吻合口漏），总再次手术率为 6.9%。严重术后并发症的发生率为 11.5%，总死亡率为 0.6%。两组在总术后发病率和死亡率方面没有差异。两组的中位住院时间相似（7 天）。
结论
MS 不会危及腹腔镜结肠切除术的术后结局。
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