肥胖对结直肠内镜黏膜下剥离术的影响：单中心回顾性队列研究。
Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study.
机构信息
Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan.
Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.
出版信息
BMC Gastroenterol. 2021 Feb 16;21(1):74. doi: 10.1186/s12876-021-01652-5.
BACKGROUND
When performing colorectal endoscopic submucosal dissection (ESD) in obese patients, technically difficult cases are sometimes experienced because of difficulty with the insertion of the colonoscope, poor scope maneuverability, or an abundance of fat tissue in the submucosal layer. Since the association between obesity and colorectal ESD has not been investigated, we evaluated the clinical impact of obesity in patients who underwent colorectal ESD.
METHODS
We retrospectively reviewed 535 patients who underwent colorectal ESD between April 2012 and February 2019. Patients were divided into three groups based on their body mass index (BMI): a control group (BMI < 25 kg/m), an overweight group (25 kg/m ≤ BMI < 30 kg/m), and an obese group (BMI ≥ 30 kg/m), and the short-term clinical outcomes were analyzed to assess the safety and difficulty of colorectal ESD.
RESULTS
No significant difference in the procedure times, en bloc resection rates, pathological diagnoses, or complications were seen among the groups. While the amount of sedative per body weight was significantly lower in the group with a higher BMI (flunitrazepam: 1.75 × 10 [1.27 × 10-2.34 × 10] mg/kg vs. 1.48 × 10 [1.08 × 10-2.03 × 10] mg/kg vs. 1.16 × 10 [0.98 × 10-1.54 × 10] mg/kg, P < 0.001; pethidine: 0.63 [0.55-0.72] mg/kg vs. 0.50 [0.46-0.56] mg/kg vs. 0.39 [0.32-0.45] mg/kg, P < 0.001), a reduction in percutaneous arterial oxygen saturation occurred significantly more frequently in the group with a higher BMI (123 [30.2%] vs. 43 [43.9%] vs. 10 [55.6%], P = 0.005). When the procedures were performed by trainees, the number of cases that required a procedure time of longer than 90 min was significantly larger in the group with a higher BMI (27 [10.8%] vs. 14 [21.9%] vs. 3 [25.0%], P = 0.033).
CONCLUSIONS
This study showed that colorectal ESD could be performed safely and effectively in obese patients. However, ESD in obese patients requires attention, particularly to changes in respiratory conditions.
背景
在为肥胖患者进行结直肠内镜黏膜下剥离术（ESD）时，由于结肠镜插入困难、镜身操作困难或黏膜下层脂肪组织丰富，有时会遇到技术上困难的病例。由于肥胖与结直肠 ESD 之间的关联尚未得到研究，我们评估了肥胖患者接受结直肠 ESD 的临床影响。
方法
我们回顾性分析了 2012 年 4 月至 2019 年 2 月期间接受结直肠 ESD 的 535 例患者。根据体重指数（BMI）将患者分为三组：对照组（BMI<25 kg/m）、超重组（25 kg/m≤BMI<30 kg/m）和肥胖组（BMI≥30 kg/m），分析短期临床结局，评估结直肠 ESD 的安全性和难度。
结果
各组在手术时间、整块切除率、病理诊断和并发症方面无显著差异。BMI 较高组的镇静剂用量（氟硝西泮：1.75×10[1.27×10-2.34×10]mg/kg 比 1.48×10[1.08×10-2.03×10]mg/kg 比 1.16×10[0.98×10-1.54×10]mg/kg，P<0.001；哌替啶：0.63[0.55-0.72]mg/kg 比 0.50[0.46-0.56]mg/kg 比 0.39[0.32-0.45]mg/kg，P<0.001）显著降低，BMI 较高组经皮动脉血氧饱和度下降发生率显著升高（123[30.2%]比 43[43.9%]比 10[55.6%]，P=0.005）。当由受训者进行手术时，BMI 较高组的手术时间超过 90 分钟的病例数显著增加（27[10.8%]比 14[21.9%]比 3[25.0%]，P=0.033）。
结论
本研究表明，肥胖患者可安全有效地进行结直肠 ESD，但肥胖患者的 ESD 需要注意呼吸状况的变化。
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