探讨高体重指数(BMI)对食管癌根治术后早期并发症的影响。

回顾性分析福建医科大学附属协和医院胸外科2014年1月至2015年12月间收治的228例行胸腹腔镜联合食管癌切除＋胸腹二野淋巴结清扫＋胃代食管(经食管床)左颈机械吻合＋空肠造瘘术的胸段食管癌患者，剔除术前接受过辅助放化疗、术前低白蛋白血症(白蛋白浓度≤35 g/L)、合并心肺基础疾病、轻BMI(BMI<18.5 kg/m²)患者，最终收集符合标准的151例患者的相关资料。将151例胸段食管癌患者分为正常BMI组和高BMI组，其中正常BMI组(18.5kg/m²≤BMI<24kg/m²)92例，高BMI组(BMI≥24 kg/m²)59例，比较两组患者术后并发症的发生率。

高BMI组患者的术后食管吻合口瘘和肺部并发症发生率均显著高于正常BMI组，差异有统计学意义(23.7% vs 7.6%，χ²＝7.80，P<0.01；84.7% vs 68.5%，χ²＝5.05，P<0.05)；但两组间切口感染、心脏并发症和乳糜胸的发生率比较，差异均无统计学意义(χ²＝0.12，χ²＝0.48，χ²＝0.23，均P<0.05)。

高BMI患者较正常BMI患者易发生吻合口瘘和肺炎，可根据患者术前BMI指导食管癌根治术后早期并发症的临床治疗。

To investigate the influence of high body mass index(BMI) on early complications after radical surgery for esophageal carcinoma.

The clinical data of 228 patients with thoracic segment esophageal carcinoma undergoing resection with thoracoscope and laparoscope plus thoraco-abdominal 2-field lymphadenectomy plus replacement of esophagus by stomach(through esophagus bed) plus percutaneous endoscopic jejunostomy between January 2014 and December 2015 in Department of Cardiothoracic Surgery, Fujian Medical University Union Hospital were retrospectively analyzed. Patients with preoperative adjuvant radio-chemotherapy treatment, hypoalbuminema(≤35 g/L), basic cardiopulmonary diseases and low BMI(BMI<18.5 kg/m²) were excluded. The clinical data of 151 eligible patients were ultimately collected, and patients were divided into normal BMI group(18.5 kg/m²≤BMI<24 kg/m^2, n=92) and high BMI group(BMI≥24 kg/m^2, n=59). The prevalences of postoperative complications were compared.

The prevalences of postoperative anastomotic leakage and pulmonary complications in high BMI group were significantly higher than those in normal BMI group(23.7% vs 7.6%, χ²=7.80, P<0.01; 84.7% vs 68.5%, χ²=5.05, P<0.05). There was no significant difference in the incidence rates of incision infection, cardiac complications and chylothorax between two groups(χ²=0.12, χ²=0.48, χ²=0.23, P<0.05 for all).

Compared with patients with normal BMI, those with high BMI are prone to anastomotic leakage and pulmonary complications. The clinical treatment of early complications after radical surgery for esophageal carcinoma can be guided on the basis of peroperative BMI.