目的

分析腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系。

方法

回顾性选取2022年1月至2024年1月收治的80例胃癌患者，均行腹腔镜全胃切除术。采用SPSS 21.0统计学软件分析数据，计数资料行χ²检验；计量资料以（±s）表示，行独立样本t检验；Logistic回归模型分析腹腔镜全胃切除术术中失血量的影响因素。P＜0.05为差异有统计学意义。

结果

所有患者均顺利完成腹腔镜全胃切除术，均获得R0切除。术前CT测得腹部内脏脂肪面积（VFA）、腹部横径（TD）、胰腺至前腹部皮肤最短距离（PAAD）、胸骨下角角度（LSA）分别为100（56.3，129.4）cm²、30（14.2，46.5）cm、59.7（20.0，119.7）mm、74.2（46.1，106.9）°。腹部形态参数VFA≥100cm²、TD≥30cm、PAAD≥59.7mm、LSA≥74.2°组术中失血量明显多于较小组，差异有统计学意义（P＜0.05）。Logistic回归分析显示：手术时间、BMI、VFA、TD、PAAD、LSA与术中失血量有关（P＜0.05），其中手术时间、VFA（≥100cm²）、PAAD（≥59.7mm）、LSA（≥74.2°）是影响术中失血量的独立危险因素（P＜0.05）。

结论

在腹腔镜全胃切除术中，腹部形态CT参数VFA≥100cm²、PAAD≥59.7mm、LSA≥74.2°时，提示手术难度增加，应高度警惕术中出血。

Objective

To analyze the relationship between abdominal morphological CT parameters and blood loss during total laparoscopic gastrectomy.

Methods

80 patients with gastric cancer admitted from January 2022 to January 2024 underwent laparoscopic total gastrectomy.SPSS 21.0 statistical software was used to analyze the data， and the counting data were tested in line 2.Measurement data were represented by （x± s ）， and independent sample t test was performed.Logistic regression model was used to analyze the influencing factors of blood loss during laparoscopic total gastrectomy.P＜0.05 was considered statistically significant.

Results

All patients successfully completed laparoscopic total gastrectomy and obtained R0 resection.Preoperative CT measurements of abdominal visceral fat area （VFA）， transverse abdominal diameter（TD）， minimum distance from pancreas to anterior abdominal skin （PAAD）， and substernal Angle （LSA） were 100 （56.3， 129.4） cm²， 30 （14.2， 46.5） cm， 59.7 （20.0）， respectively.119.7） mm， 74.2 （46.1， 106.9）°.The intraoperative blood loss of VFA≥100cm²， TD≥30cm， PAAD≥59.7mm， LSA≥74.2° group was significantly higher than that of the other group， and the difference was statistically significant （P＜0.05）.Logistic regression analysis shows: Operative time， BMI， VFA， TD， PAAD and LSA were correlated with intraoperative blood loss（P＜0.05）， and operative time， VFA （≥100cm²）， PAAD （≥59.7mm） and LSA （≥74.2°） were independent risk factors affecting intraoperative blood loss （P＜0.05）.

Conclusion

In laparoscopic total gastrectomy， when the abdominal morphology CT parameters VFA≥100cm²， PAAD≥59.7mm， LSA≥74.2°， the difficulty of surgery is increased， and intraoperative bleeding should be highly vigilant.