摘要
目的分析当前版本的华西肠癌数据库(Database from Colorectal Cancer,DACCA)中的结直肠癌患者的体质量指数(BMI)对手术难度和手术反应的影响。方法本次数据分析选取DACCA版本为2021年9月22日更新版,分析的数据项目包括BMI、手术时长、解剖难度、骨盆狭窄程度、腹部肥胖状态、术区粘连情况、系膜异常情况、组织/脏器肥大、术区肠管质量、手术总体反应评价、体温升高情况、排气间隔天数、疼痛程度和精神状态,以中国成人体质指数分类方法将患者分为偏瘦(BMI<18.5 kg/m^(2))、正常(BMI为18.5~23.9 kg/m^(2))、超重(BMI为24.0~27.9 kg/m^(2))及肥胖(BMI≥28.0 kg/m^(2))。结果按照本次研究的筛选条件从DACCA中获得6311条有效数据。①BMI对手术难度的影响:BMI与手术时长呈较弱的正相关(r_(s)=0.096,P<0.001)。超重和肥胖患者更易出现解剖异常(r_(s)=0.385,P<0.001)、骨盆狭窄(r_(s)=0.386,P<0.001)、腹部肥胖(r_(s)=0.567,P<0.001)、术区粘连(r_(s)=0.043,P=0.004)。不同BMI患者的组织/脏器肥大情况存在差异(χ^(2)=39.988,P<0.001)。还发现偏瘦患者出现术区粘连时易发展为“极重粘连”且易发生“系膜挛缩、短小、固定”,而肥胖患者则易发生“系膜肥厚”。不同BMI患者术区肠管质量比较差异无统计学意义(P>0.05)。②BMI对于手术反应的影响:BMI与手术总体反应呈较弱的正相关(r_(s)=0.049,P=0.001)且肥胖患者中对手术总体反应严重者占比最高。BMI与患者的疼痛程度呈较弱的负相关(r_(s)=–0.058,P<0.001)且偏瘦患者更易出现需要药物控制的疼痛。不同BMI患者的体温升高情况、排气间隔天数、精神状态比较差异均无统计学意义(P>0.05)。结论BMI偏高可能会使结直肠癌患者的手术难度增大,主要体现在手术时长、解剖难度、骨盆狭窄程度、腹部肥胖状态、术区粘连情况、系膜异常情况、组织/脏器肥大等指标;BMI偏高对手术反应总体而言较小,尽管会影响手术后总体反应状态,却不会影响体温升高情况、排气间隔天数、精神状态等指标。
Objective To analyze the impact of body mass index(BMI)on surgical difficulty and surgical reaction of patients with colorectal cancer served by West China Hospital,based on the current version of Database from Colorectal Cancer(DACCA).Methods The data of DACCA were updated on September 22,2021.All data items included BMI,operative duration,anatomical difficulty,pelvic stenosis,abdominal obesity,adhesion in surgical area,abnormal mesenteric status,tissue or organ hypertrophy,intestinal quality in surgical area,surgery reaction,and perioperative complications of colorectal cancer module including temperature,flatus,pain,and mental status.The patients were divided into lean(BMI<18.5 kg/m^(2)),normal(BMI 18.5–23.9 kg/m^(2)),overweight(BMI 24.0–27.9 kg/m^(2)),and obesity(BMI≥28.0 kg/m^(2))by Chinese four classification method.Results After scanning,6311 data rows were analyzed.①The effect of BMI on surgical difficulty:BMI was weakly positively correlated with operative duration(r_(s)=0.096,P<0.001).The overweight and obesity patients were more likely to have anatomical abnormalities(r_(s)=0.385,P<0.001),pelvic stenosis(r_(s)=0.386,P<0.001),abdominal obesity(r_(s)=0.567,P<0.001),and adhesion in surgical area(r_(s)=0.043,P=0.004).There was difference in tissue or organ hypertrophy among patients with different BMI(χ^(2)=39.988,P<0.001).It was also found that the lean patients were prone to develop‘very heavy adhesions’when adhesions occurred in surgical area,and to‘mesangial contracture,short,fixed’of abnormal mesenteric status,while the obesity patients were prone to‘mesangial thickening’of abnormal mesenteric status.There was no difference in intestinal quality among patients with different BMI(P>0.05).②The effect of BMI on surgical reaction:BMI was weakly positively correlated with the overall assessment of surgical reaction(r_(s)=0.049,P=0.001),and obesity patients were more likely to have severe surgical reaction.BMI was weakly negatively correlated with pain(r_(s)=–0.058,P<0.001)and the lean patients were more likely to have pain that needed drug control.However,there were no differences in temperature,flatus,and mental status among patients with different BMI(P>0.05).Conclusions High BMI of patients will affect several indicators including operative duration,anatomical difficulty,pelvic stenosis,abdominal obesity,adhesion in surgical area,abnormal mesenteric status,tissue or organ hypertrophy,resulting in increased difficulty of surgery.Although high BMI might affect overall response state after surgery,it will not affect temperature,flatus,and mental status,reflecting a relatively weak impact on surgical reaction.
作者
贺子妍
刘桂娜
邹雨恒
汪晓东
李立
HE Ziyan;LIU Guina;ZOU Yuheng;WANG Xiaodong;LI Li(Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Medicine in Sichuan University,Chengdu 610041,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2022年第1期85-92,共8页
Chinese Journal of Bases and Clinics In General Surgery
基金
四川大学大学生创新创业项目(项目编号:C2021115319、C2021115077)。
