Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Asian J Surg. 2019 Jul;42(7):768-774. doi: 10.1016/j.asjsur.2018.11.008. Epub 2018 Dec 17.
To explore the quantitative measurements and evaluation of intra-peritoneal fat distribution by MDCT and its significance in predicting intra-operative bleeding volume during D2 lymphadenectomy in gastric cancer (GC) patients.
From June 2016 to September 2017, GC patients scheduled for open gastrectomy with D2 lymph-node dissection were enrolled. According to the BMI, the subjects were then classified as normal BMI(BMI<25 kg/m); overweight (BMI = 25-30 kg/m) and obese (BMI≥30 kg/m). According to the intraoperative blood loss (IBL), the patients were further separated into high IBL (IBL; ≥ 300 ml) or low IBL (<300 ml). Clinicopathological parameters between the groups were statistically compared and univariate and multivariate analysis were used to identify predictive factors such as intra-peritoneal fat areas (IFA) and intra-peritoneal fat areas ratio (IFAR) for high IBL.
A total of 226 patients were included in the study where 53 patients underwent distal while 173 underwent total gastrectomy. According to the BMI classification, there were 25 normal BMI, 108 overweight and 25 obese subjects. According to the IBL, there were 98 high IBL and 128 low IBL subjects. IFA and IFAR were significantly greater in the high IBL group than in the low IBL group. There was no significant difference in any other clinicopathological factors between the high IBL group and the low IBL group. Multivariate analysis revealed that high IFA and IFAR independently predicted high IBL.
The use of MDCT to evaluate the precise distribution of abdominal fat during preoperative examination can prompt surgeons to develop techniques to decrease intraoperative bleeding in obese patients. Nevertheless, it is yet necessary to be surgically more meticulous when dealing with patients with high IFA or high IFA/IFAR in order to improve the outcome of D2 gastrectomy.
探讨 MDCT 对腹腔内脂肪分布的定量测量和评估及其在预测胃癌（GC）患者 D2 淋巴结清扫术中术中出血量的意义。
本研究纳入了 2016 年 6 月至 2017 年 9 月间拟行开腹胃癌根治术并接受 D2 淋巴结清扫术的 GC 患者。根据 BMI，将受试者分为正常 BMI（BMI<25 kg/m）、超重（BMI=25-30 kg/m）和肥胖（BMI≥30 kg/m）。根据术中出血量（IBL），患者进一步分为高 IBL（IBL≥300 ml）或低 IBL（IBL<300 ml）。统计比较组间临床病理参数，采用单因素和多因素分析确定 IFA 和 IFAR 等预测高 IBL 的因素。
共纳入 226 例患者，其中 53 例行远端胃切除术，173 例行全胃切除术。根据 BMI 分类，有 25 例正常 BMI，108 例超重和 25 例肥胖。根据 IBL，有 98 例高 IBL 和 128 例低 IBL。高 IBL 组的 IFA 和 IFAR 明显大于低 IBL 组。高 IBL 组与低 IBL 组在其他任何临床病理因素方面均无显著差异。多因素分析显示，高 IFA 和 IFAR 独立预测高 IBL。
术前使用 MDCT 评估腹部脂肪的精确分布，可以提示外科医生制定技术方案，以减少肥胖患者的术中出血。然而，在处理 IFA 或 IFAR 较高的患者时，仍需要更加精细的手术操作，以提高 D2 胃切除术的效果。
