Pikarsky A J, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss E G, Nogueras J J, Wexner S D
Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
Surg Endosc. 2002 May;16(5):855-8. doi: 10.1007/s004640080069. Epub 2002 Feb 6.
The aim of this study was to assess the outcome of laparoscopic colorectal surgery in obese patients and compare it to that of a nonobese group of patients who underwent similar procedures.
All 162 consecutive patients who underwent an elective laparoscopic or laparoscopic-assisted segmental colorectal resection between August 1991 and December 1997 were evaluated. Body mass index (BMI; kg/m2) was used as an objective index to indicate massive obesity. The parameters analyzed included BMI, age, gender, comorbid conditions, diagnosis, procedure, American Society of Anesthesiologists classification score, operative time, estimated blood loss, transfusion requirements, intraoperative complications, conversion to laparotomy, postoperative complications, length of hospitalization, and mortality.
Thirty-one patients (19.1%) were obese (23 males and 8 females). Conversion rates were significantly increased in the obese group (39 vs 13.5%, p = 0.01), with an overall conversion rate of 18%. The postoperative complication rate in the obese group was 78% versus 24% in the nonobese group (p <0.01). Specifically, rates of ileus and wound infections were significantly higher in the obese group [32.3 vs. 7.6% (p <0.01) and 12.9 vs 3.1%. (p = 0.03), respectively]. Furthermore, hospital stay in the obese group was longer (9.5 days) than in the nonobese group (6.9 days, p = 0.02).
Laparoscopic colorectal segmental resections are feasible in obese patients. However, increased rates of conversion to laparotomy should be anticipated and the risk of postoperative complications is significantly increased, prolonging the length of hospitalization when compared to that of nonobese patients.
本研究的目的是评估肥胖患者腹腔镜结直肠手术的结果，并将其与接受类似手术的非肥胖患者组的结果进行比较。
对1991年8月至1997年12月期间连续接受择期腹腔镜或腹腔镜辅助节段性结直肠切除术的162例患者进行了评估。体重指数（BMI；kg/m²）用作指示重度肥胖的客观指标。分析的参数包括BMI、年龄、性别、合并症、诊断、手术、美国麻醉医师协会分类评分、手术时间、估计失血量、输血需求、术中并发症、中转开腹、术后并发症、住院时间和死亡率。
31例患者（19.1%）为肥胖患者（23例男性和8例女性）。肥胖组中转率显著增加（39%对13.5%，p = 0.01），总体中转率为18%。肥胖组术后并发症发生率为78%，而非肥胖组为24%（p <0.01）。具体而言，肥胖组肠梗阻和伤口感染率显著更高[分别为32.3%对7.6%（p <0.01）和12.9%对3.1%。（p = 0.03）]。此外，肥胖组住院时间（9.5天）比非肥胖组（6.9天）更长（p = 0.02）。
肥胖患者行腹腔镜节段性结直肠切除术是可行的。然而，应预期中转开腹率会增加，且术后并发症风险显著增加，与非肥胖患者相比住院时间延长。
