1.5 小结
综上所述,肥胖结直肠癌患者有其特殊的病生理特征,可能伴有高危合并症,围手术期严格的多学科评估和及时干预是确保手术安全的重要保障;对肥胖结直肠癌病人接受腹腔镜手术需术后严密监测和警惕术后并发症发生;在外科技术层面,尾侧入路和全腔镜下吻合对于肥胖患者可能具有一定优势。
(申占龙)
参考文献
[1]World Health Organization.Obesity: preventing and managing the global epidemic.Report of a WHO consultation.technical report series[M].2000,894(i-xii): 1-253.
[2]FLEGAL K M,GRAUBARD B I,WILLIAMSON D F,et al.Cause-specific excess deaths associated with underweight,overweight,and obesity[J].JAMA,2007,298:2028-2037.
[3]WHO Expert Consultation.Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies[J].Lancet,2004,363:157-163.
[4]DI B,LI Y,WEI K,et al.Laparoscopic versus open surgery for colon cancer: a meta-analysis of 5-year follow-up outcomes[J].Surg Oncol,2013,22(3):39-43.
[5]HU F B,MANSON J E,STAMPFER M J,et al.Diet,lifestyle,and the risk of type 2 diabetes mellitus in women[J].N Engl J Med,2001,345:790-797.
[6]HORNER R L,MOHIADDIN R H,LOWELL D G,et al.Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls[J].Eur Respir J,1989,2: 613-622.
[7]KENCHAIAH S,EVANS J C,LEVY D,et al.Obesity and the risk of heartfailure[J].N Engl J Med,2002,347: 305-313.
[8]ANGULO P.Nonalcoholic fatty liver disease[J].N Engl J Med,2002,346: 1221-1231.
[9]OYASIJI T,BALDWIN K,KATZ S C,et al.Feasibility of purely laparoscopic resection of locally advanced rectal cancer in obese patients[J].World J Surg Oncol,2012,10:147.
[10]FUNG A,TRABULSI N,MORRIS M,et al.Laparoscopic colorectal cancer resections in the obese: a systematic review[J].Surg Endosc,2017,31(5): 2072-2088.(https://www.daowen.com)
[11]PARK J W,LIM S W,CHOI H S,et al.The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians[J].Surg Endosc,2010,24(7):1679-1685.
[12]XIA X,HUANG C,JIANG T,et al.Is laparoscopic colorectal cancer surgery associated with an increased risk in obese patients? A retrospective study from China[J].World J Surg Oncol,2014,12: 184.
[13]Makino T,Trencheva K,Shukla P J,et al.The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: a casematched study of 152 patients[J].Surgery,2014,156(3): 661-668.
[14]WATANABE J,TATSUMI K,OTA M,et al.The impact of visceral obesity on surgical outcomes of laparoscopic surgery for colon cancer[J].International journal of colorectal disease,2014,29: 343-351.
[15]BEGE T,LELONG B,FRANCON D,et al.Impact of obesity on short-term results of laparoscopic rectal cancer resection[J].Surg Endosc,2009,23: 1460-1464.
[16]LEROY J,ANANIAN P,RUBINO F,et al.The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy[J].Ann Surg,2005,241(1): 69-76.
[17]LASCANO C A,KAIDAR-PERSON O,SZOMSTEIN S,et al.Challenges of laparoscopic colectomy in the obese patient: a review[J].Am J Surg,2006,192(3): 357- 365.
[18]张宏,刘金钢,主译.腹腔镜下大肠癌手术[M].北京: 人民卫生出版社,2015:116-133.
[19]ZOU L N,LU X Q,WAN J.Techniques and Feasibility of the Caudal-to-Cranial Approach for Laparoscopic Right Colectomy With Complete Mesenteric Excision[J].Dis Colon Rectum,2017,60(4):e23-e24.
[20]余志清,杜江.尾侧入路与中间入路行腹腔镜下右半结肠癌根治术临床疗效对比[J].中华普外科手术学杂志(电子版),2019,13(4): 382-384.
[21]RAFTOPOULOS I,COURCOULAS A P,BLUMBERG D.Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign or malignant disease of the colon? [J].Surgery,2006,140(4):675-682.
[22]VIGNALI A,ELMORE U,LEMMA M,et al.Intracorporeal versus Extracorporeal Anastomoses Following Laparoscopic Right Colectomy in Obese Patients: A Case-Matched Study[J].Dig Surg,2018,35(3):236-242.