完全腹腔鏡下幽門側胃切除術に肥満，性別が及ぼす影響

The impact of obesity and sex on totally laparoscopic distal gastrectomy

◆要旨：完全腹腔鏡下幽門側胃切除術（TLDG）に肥満，性別が及ぼす影響を検討した．2005年1月〜2011年12月に胃癌の診断でTLDGを施行した263例をBMI 25kg/m²で2群に分け手術成績を比較し，さらに男女で分けてサブグループ解析を行った．結果，男性は非肥満女性との間に手術時間，出血量，郭清リンパ節個数で有意差を認めた．男性は肥満によりさらに郭清個数が減少したが，女性はいずれの項目も影響を受けなかった．男性へのTLDG施行では，手術難度の上昇，郭清リンパ節個数の減少に留意し，精緻な手術を行うべきと考えられた．

　We investigated the impact of obesity and sex on totally laparoscopic distal gastrectomy（TLDG）. Between January 2005 and December 2011, 263 patients with preoperatively-diagnosed gastric carcinoma underwent TLDG in our department. We classified these patients into 2 groups, an obese group and a non-obese group, on the basis of body mass index（BMI）, and analyzed perioperative data retrospectively. Furthermore, we also analyzed the above data based on sex. Concerning the perioperative data, obesity was related to longer operative time, large amount of bleeding, longer post-operative hospital stay, and less number of dissected lymph nodes. In an obese male patient group, the number of dissected lymph nodes was less than that in the non-obese group; female groups were not affected by obesity. In conclusion, TLDG on obese male patients should be performed carefully, taking into account the possibility of decreased number of dissected lymph nodes.