Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
Eur J Radiol. 2023 May;162:110768. doi: 10.1016/j.ejrad.2023.110768. Epub 2023 Mar 9.
To evaluate predictive values of body composition parameters measured from preoperative CT/MRIs for postoperative complications after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) in patients with obesity.
In this retrospective case-control study, patients performing abdominal CT/MRIs within one month before and developing 30-day complications after bariatric procedures were matched for age, sex, and type of surgery with patients without complications (1/3 ratio, respectively). Complications were determined by documentation in the medical record. Two readers blindly segmented the total abdominal muscle area (TAMA) and visceral fat area (VFA) using predetermined thresholds for the Hounsfield unit (HU) on unenhanced CT and the signal intensity (SI) on T1-weighted MRI at the L3 vertebral level. Visceral obesity (VO) was defined as VFA > 136 cm in males and > 95 cm in females. These measures, along with perioperative variables, were compared. Multivariate logistic regression analyses were performed.
Of 145 included patients, 36 had postoperative complications. No significant differences between LSG and LRYGB were present regarding complications and VO. Hypertension (p = 0.022), impaired lung function (p = 0.018), American Society of Anesthesiologists (ASA) grade (p = 0.046), VO (p = 0.021), and VFA/TAMA ratio (p < 0.0001) were associated with postoperative complications in the univariate logistic analysis; the VFA/TAMA ratio was the only independent predictor in multivariate analyses (OR 2.01, 95% CI 1.37-2.93, p < 0.001).
The VFA/TAMA ratio provides important perioperative information in predicting patients who are likely to develop postoperative complications undergoing bariatric surgery.
评估肥胖患者腹腔镜袖状胃切除术（LSG）和 Roux-en-Y 胃旁路术（LRYGB）术前 CT/MRI 测量的体成分参数对术后并发症的预测价值。
在这项回顾性病例对照研究中，对术前一个月内进行腹部 CT/MRI 检查且术后 30 天内发生并发症的患者，与无并发症患者进行年龄、性别和手术类型匹配（分别为 1/3 比例）。并发症通过病历记录确定。两名读者在 L3 椎体水平的未增强 CT 上使用 HU 预设阈值和 T1 加权 MRI 上的信号强度（SI），对总腹部肌肉面积（TAMA）和内脏脂肪面积（VFA）进行盲法分割。内脏肥胖（VO）定义为男性 VFA＞136cm，女性 VFA＞95cm。比较这些测量值与围手术期变量。进行多变量逻辑回归分析。
在 145 名纳入患者中，36 名患者发生术后并发症。LSG 和 LRYGB 在并发症和 VO 方面无显著差异。高血压（p=0.022）、肺功能受损（p=0.018）、美国麻醉医师协会（ASA）分级（p=0.046）、VO（p=0.021）和 VFA/TAMA 比值（p＜0.0001）在单变量逻辑分析中与术后并发症相关；VFA/TAMA 比值是多变量分析中的唯一独立预测因子（OR 2.01，95%CI 1.37-2.93，p＜0.001）。
VFA/TAMA 比值在预测肥胖患者接受减重手术后发生术后并发症方面提供了重要的围手术期信息。
