【摘要】 目的 探讨肥胖对腹腔镜辅助胃癌手术的近期疗效及人类表皮生长因子受体2(HER2)表达状态，为促进肥胖胃癌患者的手术治疗提供一些见解。方法 回顾性分析2015年1月至2019年6月南方医科大学附属小榄医院普外科收治的82例行腹腔镜辅助胃癌根治术患者的临床资料，分为肥胖组[体重指数(BMI)≥25 kg/m~2,30例]和非肥胖组(BMI<25 kg/m~2,52例)。比较2组患者手术相关和术后恢复指标，探讨肥胖对HER2表达的影响。结果 肥胖组患者手术时间[(330.10±61.86)min]明显长于非肥胖组[296.37±72.23)min],Lauren分型的肠型、弥漫型、混合型患者比例均明显高于[分别为60.0%(18/30)、30.0%(9/30)、10.0%(3/30)]非肥胖组[分别为30.7%(16/52)、55.8%(29/52)、13.5%(7/52)],差异均有统计学意义(P<0.05);术中出血量[(366.16±98.55)mL]、淋巴结清扫数量[(21.56±3.23)枚]、术后恢复排气时间[(3.37±0.75)d]、术后进食时间[(3.58±0.45)d]、术后引流管留置时间[(7.08±1.89)d]、术后住院时间[(10.73±2.37)d]、术后并发症率[23.3%(7/30)]与非肥胖组[分别为(337.12±97.22)mL、(22.67±3.61)枚、(3.20±0.73)d、(3.74±0.47)d、(7.21±1.45)d、(10.23±2.71)d、28.8%(15/52)]比较，差异均无统计学意义(P>0.05);HER2阳性率[10.0%(3/30)]低于非肥胖组[15.4%(8/52)],但差异无统计学意义(P>0.05)。结论 当以BMI≥25 kg/m~2为肥胖判定标准时暂不能排除肥胖对胃癌患者HER2表达状态存在影响，肥胖者腹腔镜辅助胃癌手术的手术时间更长，术中解剖需坚持个体化原则，但不影响术后近期恢复。更多还原

【Abstract】 Objective To investigate the short-term efficacy of laparoscopic-assisted gastric cancer surgery in obese patients and the expression of human epidermal growth factor receptor 2(HER2),and to provide some insights for promoting the surgical treatment of obese gastric cancer patients.Methods The clinical data of 82 cases with gastric cancer who underwent laparoscopic-assisted radical gastrectomy in the Department of General Surgery of the Xiaolan Hospital Affiliated of Southern Medical University from January 2015 to June 2019 were collected retrospectively, and they were divided into the obese group(BMI≥25 kg/m~2,30 cases) and the non-obese group(BMI<25 kg/m~2,52 cases).The indexes of operation-related and postoperative recovery were compared between the two groups, and the influence of obesity on HER2 expression was discussed.Results The operation time of obese patients(330.10±61.86)min was significantly longer than that of non-obese patients(296.37±72.23)min and the proportion of patients with intestinal type, diffuse type and mixed type classified by Lauren [60.0%(18/30),30.0%(9/30) and 10.0%(3/30),respectively] was significantly higher than that of non-obese group [30.7%(16/52),55.8%(29/52) and 13.5%(7/52),respectively].The differences were statistically significant(P<0.05).There were no significant differences in intraoperative blood loss(366.16±98.55)mL,number of lymph node dissection(21.56±3.23),postoperative recovery time of exhaust(3.37±0.75)d, postoperative eating time(3.58±0.45) d, postoperative indwelling time of drainage tube(7.08±1.89)d, postoperative complication rate [23.3%(7/30)],and postoperative hospitalization time(10.73±2.37)d compared with that of non-obese group [(337.12±97.22)mL,(22.67±3.61)pieces,(3.20±0.73)d,(3.74±0.47)d, 7.21±1.45)d,(10.23±2.71)d, 28.8%(15/52),respectively].The positive rate of HER2 in the obese group was lower than that in the non-obese group(10% vs.15.4%,P>0.05).Conclusion When BMI≥25 kg/m~2 is taken as the criterion for obesity, the results of current samples cannot exclude the influence of obesity on the expression of HER2 in gastric cancer.The operation time of obese patients assisted by laparoscopy is longer.Intraoperative anatomy should adhere to the principle of individuality, but not affect recent postoperative recovery.更多还原