Gendall Kelly A, Raniga Sumit, Kennedy Ross, Frizelle Frank A
Colorectal Unit, Department of Surgery, Christchurch Hospital, Riccarton Avenue, Christchurch, New Zealand.
Dis Colon Rectum. 2007 Dec;50(12):2223-37. doi: 10.1007/s10350-007-9051-0. Epub 2007 Sep 27.
There is an epidemic of obesity in the Western world and its associated substantial morbidity and mortality. This review examines the data on the impact of obesity on perioperative morbidity and mortality specifically in the context of colorectal surgery.
MEDLINE, PUBMED, and the Cochrane library were searched for relevant articles. A manual search for other pertinent papers also was performed.
There is good evidence that obesity is a risk factor for wound infection after colorectal surgery. Obesity may increase the risk of wound dehiscence, incisional site herniation, and stoma complications. Obesity is linked to anastomotic leak, and obese patient undergoing rectal resections may be at particular risk. There is little data on the impact of obesity on pulmonary and cardiovascular complications after colorectal surgery. Operation times are longer for rectal procedures in obese patients, but hospital stay is not prolonged. Obese patients undergoing laparoscopic colorectal surgery are at increased risk of conversion to an open procedure.
Obesity has a negative impact on outcome after colorectal surgery. To further clarify the impact of obesity on surgical outcome, it is recommended that future studies examine grades of obesity and include measures of abdominal obesity.
西方世界存在肥胖流行现象及其相关的大量发病和死亡情况。本综述专门在结直肠手术背景下研究肥胖对围手术期发病和死亡影响的数据。
检索MEDLINE、PUBMED和Cochrane图书馆以查找相关文章。还进行了手动搜索其他相关论文。
有充分证据表明肥胖是结直肠手术后伤口感染的危险因素。肥胖可能增加伤口裂开、切口部位疝和造口并发症的风险。肥胖与吻合口漏有关，接受直肠切除术的肥胖患者可能尤其危险。关于肥胖对结直肠手术后肺部和心血管并发症影响的数据很少。肥胖患者进行直肠手术的手术时间较长，但住院时间并未延长。接受腹腔镜结直肠手术的肥胖患者转为开放手术的风险增加。
肥胖对结直肠手术后的结局有负面影响。为进一步阐明肥胖对手术结局的影响，建议未来研究检查肥胖等级并纳入腹部肥胖的测量指标。
