Hedican Sean P, Moon Timothy D, Lowry Patrick S, Nakada Stephen Y
Department of Surgery, Division of Urology, University of Wisconsin, Madison, Wisconsin 53792, USA.
J Endourol. 2004 Apr;18(3):241-4. doi: 10.1089/089277904773582831.
Obesity has been regarded as a relative contraindication to standard laparoscopic procedures. We evaluated the impact of morbid (body mass index [BMI] >30 kg/m2) and profound (BMI > 40 kg/m2) obesity on the results of hand-assisted laparoscopic renal surgery (HALRS).
From September 1996 until October 2002, a total of 30 patients among 105 on whom HALRS was performed at our institution were morbidly obese, with a mean BMI of 35.8 kg/m2 (range 30.3-52.3 kg/m2). Eight patients were noted to have profound obesity, with a mean BMI of 44 kg/m2 (range 40.1-52.3 kg/m2). The HALRS procedures included radical nephrectomy in 23 patients, simple nephrectomy in 4, nephroureterectomy in 2, and partial nephrectomy in 1. At least one additional significant comorbidity was noted in 70% of these patients. We retrospectively evaluated the intraoperative and postoperative outcomes in this group of obese patients.
All procedures were performed successfully without the need for open conversion. The mean operative time was 262 minutes (range 125-361 minutes), and the mean estimated blood loss was 217 mL (range 50-600 mL). No transfusions or intraoperative complications occurred. The mean hospital stay was 4.1 days (range 2-13 days). There were 7 minor postoperative complications including ileus (N = 5), wound cellulitis (1), and urinary retention (1). No complications occurred in the profoundly obese patient subgroup.
Hand-assisted laparoscopic renal surgery is safe and effective in the morbidly and profoundly obese patient.
肥胖一直被视为标准腹腔镜手术的相对禁忌证。我们评估了病态肥胖（体重指数[BMI]>30kg/m²）和重度肥胖（BMI>40kg/m²）对手助腹腔镜肾手术（HALRS）结果的影响。
从1996年9月至2002年10月，在我们机构接受HALRS手术的105例患者中，共有30例病态肥胖，平均BMI为35.8kg/m²（范围30.3 - 52.3kg/m²）。8例患者为重度肥胖，平均BMI为44kg/m²（范围40.1 - 52.3kg/m²）。HALRS手术包括23例行根治性肾切除术、4例行单纯肾切除术、2例行肾输尿管切除术、1例行部分肾切除术。这些患者中有70%至少合并一种其他严重疾病。我们回顾性评估了这组肥胖患者的术中及术后结果。
所有手术均成功完成，无需转为开放手术。平均手术时间为262分钟（范围125 - 361分钟），平均估计失血量为217mL（范围50 - 600mL）。未发生输血或术中并发症。平均住院时间为4.1天（范围2 - 13天）。有7例轻微术后并发症，包括肠梗阻（5例）、伤口蜂窝织炎（1例）和尿潴留（1例）。重度肥胖患者亚组未发生并发症。
手助腹腔镜肾手术在病态肥胖和重度肥胖患者中是安全有效的。
