Kuligowska Anna, Majewski Włodzimierz D
Samodzielna Pracownia Pielegniarstwa Chirurgicznego Pomorskiej Akademii Medycznej w Szczecinie, Szczecin.
Ann Acad Med Stetin. 2007;53(3):119-27.
Obesity usually depreciates early results of abdominal operations performed in an open way, but not always after laparoscopic operations. Aim of the study is to compare early results and quality of life after most common abdominal operations (cholecystectomy and appendectomy) performed on obese and non-obese patients.
166 patients who were operated in academic teaching hospital, were analyzed in groups: cholecystectomy - laparoscopic (74) and open (30), appendectomy - laparoscopic (30) and open (32). Every group was divided into subgroups with normal body mass, obesity I obesity II and was assessed retrospectively and investigated by Gastrointestinal Quality of Life Index (GQLI) up to 5 months after intervention by registered nurse specialized in surgery. Number and gravity of complications were assessed as well as hospital stay and convalescence time.
There were 7/19 and 4/13 complications after laparoscopic vs 8/12 and 7/19 after open cholecystectomies and appendectomies respectively in groups with normal body weight (BMI 18.5-24.9kg/m2), and 28/56 and 8/20 complications after laparoscopic vs 14/18 and 9/12 after open cholecystectomies and appendectomies respectively in obese groups (above 25 kg/m2). One conversion to open surgery occured in patient with obesity I for laparoscopic cholecystectomy and one in normal body mass patient for laparoscopic appendectomy. There was one case of common bile duct lesion in obese patient during laparoscopic intervention and two cases of intestinal obstruction after open cholecystectomy in obese patients. Mean hospital stay time was 3.2 and 3.8 days after laparoscopic operations vs 5.4 and 5.4 days after open ones respectively. Mean convalescence time was 14 and 14 days after laparoscopic operations vs 21 and 14 days after open cholecystectomy and appendectomy respectively. Quality of life was significantly better after laparoscopic than open cholecystectomy in obese patients (128.4 +/- 12.7 vs 120.6 +/- 12.2 respectively) but significantly worse after laparoscopic than open appendectomy (121 +/- 15.2 vs 133.8 +/- 12.9 respectively). In groups with normal body mass differences were not significant.
There is the influence of obesity on number and burden of postoperative complications after laparoscopic and open operations, however laparoscopic access seems more effective. Although hospital stay time was shorter after both types of laparoscopic operations, convalescence time was shorter only after laparoscopic cholecystectomy. The choice of type of operation (open or laparoscopic) influences the quality of life of obese patients but not on those with normal body mass. Although these conclusions seem rather clear, verification of them on larger group of patients is mandatory.
肥胖通常会降低开腹腹部手术的早期效果，但腹腔镜手术后并非总是如此。本研究的目的是比较肥胖和非肥胖患者进行最常见的腹部手术（胆囊切除术和阑尾切除术）后的早期效果和生活质量。
对在学术教学医院接受手术的166例患者进行分组分析：胆囊切除术——腹腔镜手术（74例）和开腹手术（30例），阑尾切除术——腹腔镜手术（30例）和开腹手术（32例）。每组再分为体重正常、I度肥胖、II度肥胖亚组，由专门从事外科手术的注册护士进行回顾性评估，并在干预后长达5个月的时间里通过胃肠道生活质量指数（GQLI）进行调查。评估并发症的数量和严重程度以及住院时间和康复时间。
体重正常组（BMI 18.5 - 24.9kg/m²）中，腹腔镜胆囊切除术和阑尾切除术后的并发症分别为7/19和4/13例，开腹胆囊切除术和阑尾切除术后分别为8/12和7/19例；肥胖组（BMI高于25kg/m²）中，腹腔镜胆囊切除术和阑尾切除术后的并发症分别为28/56和8/20例，开腹胆囊切除术和阑尾切除术后分别为14/18和9/12例。1例I度肥胖患者腹腔镜胆囊切除术中转开腹，1例体重正常患者腹腔镜阑尾切除术中转开腹。1例肥胖患者在腹腔镜干预期间发生胆总管损伤，2例肥胖患者开腹胆囊切除术后发生肠梗阻。腹腔镜手术后平均住院时间分别为3.2天和3.8天，开腹手术后分别为5.4天和5.4天。腹腔镜胆囊切除术和阑尾切除术后平均康复时间分别为14天和14天，开腹胆囊切除术和阑尾切除术后分别为21天和14天。肥胖患者腹腔镜胆囊切除术后的生活质量明显优于开腹手术（分别为128.4±12.7和120.6±12.2），但腹腔镜阑尾切除术后的生活质量明显差于开腹手术（分别为121±15.2和133.8±12.9）。体重正常组差异不显著。
肥胖对腹腔镜手术和开腹手术后并发症的数量和负担有影响，但腹腔镜手术入路似乎更有效。虽然两种腹腔镜手术后住院时间较短，但仅腹腔镜胆囊切除术后康复时间较短。手术方式（开腹或腹腔镜）的选择会影响肥胖患者的生活质量，但对体重正常的患者没有影响。尽管这些结论似乎相当明确，但仍需在更大规模的患者群体中进行验证。
