目的    评估皮下脂肪组织（SAT）和内脏脂肪组织（VAT）的放射学特征与腹腔镜辅助全胃切除术后近期疗效的相关性。方法    回顾性分析2014年1月至2021年12月复旦大学附属肿瘤医院胃外科收治的180例行腹腔镜辅助全胃切除术的胃腺癌病人的临床资料。Slice-O-Matic 5.0软件计算病人身高校正后的SAT面积（SAT-M）和VAT面积（VAT-M）以及SAT密度、VAT密度，分析其与腹腔镜全胃切除术近期疗效和并发症的关系。结果    VAT-M面积与术中出血量、手术时间呈显著正相关（r=0.259、0.225，P<0.01），而与清扫淋巴结数目呈显著负相关（r=-0.257，P<0.01）。SAT-M面积与手术时间呈显著正相关（r=0.152，P<0.05），VAT密度、SAT密度与手术时间呈显著负相关（r=-0.238、-0.149，P<0.05）。按术后有无并发症分组，相较于无并发症组（163例），有并发症组（17例）的VAT-M面积更大［（70.4±20.9） vs. （52.4±24.9），t=2.880，P=0.004］，住院时间更长［（23.0±19.5） vs. （8.3±1.8），t=3.108，P=0.007］。Logistic多因素分析显示VAT-M是术后近期并发症的独立危险因素（≥65 cm2/m2 vs. <65 cm2/m2，OR=5.505，95%CI 1.623-18.669，P=0.006）。结论  腹腔VAT的增加延长了手术时间，增加了术中出血量以及术后并发症发生率，是影响手术安全及病人术后恢复的重要因素。

Association between radiological features of adipose tissue and short-term outcomes and complications after laparoscopic-assisted total gastrectomy for gastric cancer        ZHANG Yu，HU Bo-yang，ZANG Ming-de，et al. Department of Gastric Surgery，Fudan University Shanghai Cancer Center; Department of Oncology，Shanghai Medical College，Fudan University，Shanghai 200032，China
Corresponding author：HUANG Hua，E-mail：huahuangvip@sina.com
ZHANG Yu and HU Bo-yang are the first authors who contributed equally to the article
Abstract    Objective    To evaluate the correlation of radiological features of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) with the short-term outcomes and postoperative complications of laparoscopic-assisted total gastrectomy. Methods    From January 2014 to December 2021，a total of 180 patients undergoing laparoscopic-assisted total gastrectomy were included. Slice-O-Matic 5.0 was used to measure the height corrected SAT(SAT-M) and VAT(VAT-M) and adipose tissue density of CT image slices, and the relationship between these variables and the short-term outcomes and postoperative complications were evaluated. Results    VAT-M area had a significant positive correlation with the intraoperative blood loss and the operation time（P<0.01），while it had a significant negative correlation with the number of retrieved lymph node（P<0.01）. SAT-M area showed a significant positive correlation with operation time (P < 0.05). VAT density and SAT density showed a significant negative correlation with operation time (P<0.05). Compared with the non-complication group（163 cases），the complication group（17 cases） had larger VAT-M area［(70.4±20.9) vs. (52.4±24.9), t=2.880,P=0.004］ and longer postoperative hospital stay［(23.0±19.5) vs. (8.3±1.8), t=3.108, P=0.007)］. Multivariate analysis showed VAT-M area was an independent risk factor for postoperative complications (≥65 cm2/m2 vs. ＜65 cm2/m2, OR=5.505，95%CI 1.623-18.669，P=0.006). Conclusion    A high VAT-M area in gastric cancer patients undergoing laparoscopic-assisted total gastrectomy will increase the difficulty of the operation, prolong the operation time, increase operative bleeding and difficulty of lymph node dissection, and increase the short-term postoperative complications.