Mediastinal adiposity influences the technical difficulty of thoracic procedure in minimally invasive esophagectomy
Mediastinal adiposity influences the technical difficulty of thoracic procedure in minimally invasive esophagectomy
复制标题
纵隔肥胖影响微创食管切除术胸腔手术技术难度
DOI：
10.1007/s00268-016-3562-6
复制
发表时间：
2016
期刊：
影响因子：
2.6
通讯作者：
Shinji Mine
中科院分区：
文献类型：
--
作者：
Okamura A;Watanabe M;Takanori Kurogochi;Yu Imamura;Koujiro Nishida;Shinji Mine
背景：肥胖被认为是影响手术难度的因素。然而，纵隔脂肪是否会影响微创食管切除术（MIE）胸椎手术的难度尚不清楚。方法对2012 - 2014年接受MIE手术的142例患者进行ct体积测量。我们测量了腹部内脏脂肪面积（AVFA）在脐水平和纵隔脂肪面积（MFA）在气管隆突水平。以胸椎手术时间为参数评估MFA对胸椎手术难度的影响，并评估MFA对MIE术后发病率的影响。结果smfa明显小于AVFA （p< 0.01）。两者呈正相关（p< 0.01）。MFA与胸椎手术时间呈正相关（p< 0.01）。多因素分析显示MFA与胸部手术时间延长独立相关（p< 0.01）。关于与胸椎手术相关的术后并发症，有无肺炎患者和有无乳糜胸患者的MFA无显著差异。复发性喉神经麻痹（RLNP）患者的MFA高于无复发性喉神经麻痹患者（p= 0.04）。多因素分析显示MFA是RLNP发生的显著预测因子（p= 0.04）。结论纵隔脂肪的程度远小于腹部内脏脂肪，但纵隔脂肪可作为胸腔镜手术难度及发生RLNP风险的预测因素。
BackgroundObesity is considered to influence the difficulty of surgery. However, whether mediastinal adiposity influences the difficulty of the thoracic procedure in minimally invasive esophagectomy (MIE) remains unclear.MethodsComputed tomography volumetry was performed in 142 patients who underwent MIE between 2012 and 2014. We measured abdominal visceral fat area (AVFA) at the umbilicus level and mediastinal fat area (MFA) at the tracheal carina level. The influence of MFA on the difficulty of the thoracic procedure was assessed using the thoracic procedure duration as a parameter, and the effect of MFA on morbidity after MIE was assessed.ResultsMFA was significantly smaller than AVFA (p< 0.01). There was a positive correlation between them (p< 0.01). A significant positive correlation was observed between MFA and thoracic procedure duration (p< 0.01). Multivariate analysis revealed that MFA was independently correlated with prolonged thoracic procedure duration (p< 0.01). Regarding postoperative complications associated with the thoracic procedure, there were no significant differences in MFA between patients with or without pneumonia and those with or without chylothorax. Patients who experienced recurrent laryngeal nerve palsy (RLNP) had greater MFA than those who did not (p= 0.04). Multivariate analysis revealed that MFA was a significant predictor of the occurrence of RLNP (p= 0.04).ConclusionsAlthough the extent of mediastinal adiposity was much lesser than that of abdominal visceral adiposity, it could be a predictor of the difficulty of the thoracic procedure as well as the risk of RLNP in MIE.