2024 年第 2 期 第 19 卷

肥胖对下肢继发性淋巴水肿患者淋巴水肿抽吸术术中指标的影响

The effect of obesity on intraoperative indicators of lymphedema aspiration surgery in patients with secondary lower limb lymphedema

作者：郝昆1张丽2刘璇3孙宇光1信建峰1王仁贵4沈文彬1

英文作者：Hao Kun1 Zhang Li2 Liu Xuan3 Sun Yuguang1 Xin Jianfeng1 Wang Rengui4 Shen Wenbin1

单位：1首都医科大学附属北京世纪坛医院淋巴外科首都医科大学淋巴管疾病临床诊疗与研究中心，北京100038；2首都医科大学附属北京世纪坛医院核医学科，北京100038；3首都医科大学附属北京世纪坛医院输血科，北京100038；4首都医科大学附属北京世纪坛医院放射科，北京100038

英文单位：1Department of Lymphatic Surgery Beijing Shijitan Hospital Capital Medical University Clinical Diagnosis Treatment and Research Center for Lymphatic Vascular Diseases at Capital Medical University Beijing 100038 China; 2Department of Nuclear Medicine Beijing Shijitan Hospital Capital Medical University Beijing 100038 China; 3Department of Blood Transfusion Beijing Shijitan Hospital Capital Medical University Beijing 100038 China; 4Department of Radiology Beijing Shijitan Hospital Capital Medical University Beijing 100038 China

关键词：淋巴水肿；肥胖；体重指数；淋巴水肿抽吸术

英文关键词：Lymphedema;Obesity;Bodymassindex;Lymphedemaaspirationsurgery

• 摘要：

• 目的  探讨肥胖对下肢继发性淋巴水肿患者淋巴水肿抽吸术术中指标的影响。方法  回顾2020年1月至2023年1月首都医科大学附属北京世纪坛医院收治的行淋巴水肿抽吸术的152例妇科恶性肿瘤根治术相关单下肢继发性淋巴水肿患者的病历资料，按照体重指数分为肥胖组（体重指数≥28 kg/m2，66例）和非肥胖组（体重指数<28 kg/m2，86例），分析2组患者的临床和手术资料，并采用多元线性回归方法分析影响术中出血量的因素。结果  2组患者年龄、反映患肢肿胀程度的指标相对度量系数差异均无统计学意义（均P>0.05）。肥胖组体重指数、手术时间、注入膨胀液量、吸出脂肪悬浊液量、吸脂量、术中出血量大于/长于/多于非肥胖组［（30.8±2.3）kg/m2比（24.6±2.1）kg/m2、（173±41）min比（158±31）min、（4 591±1 408）ml比（4 177±1 028）ml、（7 310±2 580）ml比（5 943±1 441）ml、（3 497±1 195）ml比（2 961±1 021）ml、（574±260）ml比（428±158）ml］，差异均有统计学意义（均P<0.05）。多元线性回归分析发现体重指数（B值=13.065，95%置信区间：4.296～21.834，P=0.004）以及吸出脂肪悬浊液量（B值=0.056，95%置信区间：0.028～0.085，P<0.001）是影响术中出血量的因素。结论  肥胖患者淋巴水肿抽吸术的出血量、吸脂量明显多于非肥胖患者。高体重指数是影响术中出血量的因素之一。

• Objective  To explore the effect of obesity on intraoperative indicators of lymphedema aspiration surgery in patients with secondary lower limb lymphedema. Methods  A retrospective study was conducted on 152 patients with secondary lymphedema of single lower limb after radical resection of gynecological malignant tumors from January 2020 to January 2023 in Beijing Shijitan Hospital, Capital Medical University. They were divided into obese group(body mass index≥28 kg/m2, 66 cases)and non obese group(body mass index<28 kg/m2, 86 cases) based on body mass index. The surgical data and postoperative outcomes of the two groups of patients were analyzed, and the factors affecting intraoperative bleeding were analyzed using multiple linear regression. Results  There were no statistically significant differences in age and relative measurement coefficient of indicators reflecting the degree of limb swelling between the two groups (both P>0.05). Body mass index, surgical time, injection volume of swelling fluid, suction volume of fat suspension, liposuction volume, intraoperative bleeding volume in obese group were greater/longer/more than those in non obese group［(30.8±2.3)kg/m2 vs (24.6±2.1)kg/m2, (173±41)min vs (158±31)min, (4 591±1 408)ml vs (4 177±1 028)ml, (7 310±2 580)ml vs (5 943±1 441)ml, (3 497±1 195)ml vs (2 961±1 021)ml, (574±260)ml vs (428±158)ml］(all P<0.05). Multiple linear regression analysis showed that body mass index(B value=13.065, 95% confidence interval: 4.296-21.834, P=0.004) and suction volume of fat suspension(B value=0.056, 95% confidence interval: 0.028-0.085, P<0.001) were factors affecting intraoperative bleeding volume. Conclusions    The amount of bleeding and liposuction during lymphedema aspiration surgery in obese patients is significantly more than that in non obese patients. High body mass index is one of the factors affecting bleeding volume.