Klingler H C, Remzi M, Janetschek G, Marberger M
Department of Urology, University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
Eur Urol. 2003 May;43(5):522-7. doi: 10.1016/s0302-2838(03)00092-7.
Aim of this prospective study was to determine whether patients with a higher body mass index (BMI) will benefit more from laparoscopic procedures in respect to postoperative morbidity and pain as compared to regular patients.
Between September 1999 and October 2001, we performed 36 laparoscopic radical nephrectomies and 18 nephron sparing partial nephrectomies for renal cell carcinoma and 6 nephrectomies for benign disease (group 1, n=60). In addition, we performed 24 open radical nephrectomies and 18 nephron spearing interventions for renal cell carcinoma (group 2, n=42). Mean age was 59+/-17.9 years and average BMI was 27.1+/-3.3 kg/m(2) in the entire group. All techniques were evaluated for intraoperative results and complications. Postoperative morbidity was assessed in all patients by quantifying pain medication and by daily evaluation of Visual Analogue Scale (VAS).
Mean hospitalisation time in group 1 as compared to group 2 was 10.1 days versus 5.4 days, average operating time was 273 minutes versus 187 minutes, mean length of skin incision was 7.2 cm versus 30.8 cm. Overall analgesic consumption was lower in the laparoscopic group (190 mg versus 590 mg, p<0.001), in patients with a BMI >28 kg/m(2) the difference was even more pronounced (160 mg versus 210 mg, p=0.032). In group 1, patients with a BMI >28 kg/m(2) had significantly less pain on the first and fourth postoperative day in a linear regression analysis (VAS1=10.714-0.218 BMI; r=0.688 (p<0.001) and VAS4=3.98-0.09 BMI, r=0.519 (p<0.001), respectively). In group 1, 3/60 (5.0%) and in group 2, 5/42 (11.9%) complications occurred, no difference was found in respect to a high BMI (p=0.411).
Patients with a higher BMI (cut-off >28 kg/m(2)) benefit more from laparoscopy than slim patients in respect to postoperative pain and morbidity but do not experience more complications. Consequently, reluctance to perform laparoscopic procedures in patients with a higher BMI is no longer justified.
本前瞻性研究的目的是确定与普通患者相比，体重指数（BMI）较高的患者在术后发病率和疼痛方面是否能从腹腔镜手术中获得更多益处。
1999年9月至2001年10月期间，我们对60例患者进行了手术，其中36例为腹腔镜根治性肾切除术，18例为保留肾单位的肾部分切除术用于治疗肾细胞癌，6例为良性疾病的肾切除术（第1组）。此外，我们还进行了24例开放性根治性肾切除术和18例肾细胞癌的保留肾单位手术（第2组）。整个组的平均年龄为59±17.9岁，平均BMI为27.1±3.3kg/m²。对所有技术的术中结果和并发症进行了评估。通过量化止痛药用量和每日视觉模拟评分（VAS）对所有患者的术后发病率进行评估。
第1组的平均住院时间与第2组相比为10.1天对5.4天，平均手术时间为273分钟对187分钟，平均皮肤切口长度为7.2cm对30.8cm。腹腔镜组的总体镇痛药消耗量较低（190mg对590mg，p<0.001），在BMI>28kg/m²的患者中差异更为明显（160mg对210mg，p=0.032）。在第1组中，在线性回归分析中，BMI>28kg/m²的患者在术后第1天和第4天的疼痛明显较轻（VAS1=10.714 - 0.218BMI；r=0.688（p<0.001）和VAS4=3.98 - 0.09BMI，r=0.519（p<0.001））。在第1组中，3/60（5.0%）发生了并发症，在第2组中，5/42（11.9%）发生了并发症，在高BMI方面未发现差异（p=0.411）。
BMI较高（临界值>28kg/m²）的患者在术后疼痛和发病率方面比体型苗条的患者从腹腔镜手术中获益更多，但并发症并未增多。因此，不再有理由不愿意为BMI较高的患者进行腹腔镜手术。
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