Kamoun Sandrine, Alves Arnaud, Bretagnol Frédéric, Lefevre Jeremy H, Valleur Patrice, Panis Yves
Department of Colorectal Surgery, Beaujon Hospital, Clichy, France.
Am J Surg. 2009 Sep;198(3):450-5. doi: 10.1016/j.amjsurg.2008.09.022. Epub 2009 Mar 12.
Because it has been suggested that obese patients may be at higher risk of morbidity and mortality after surgery, we conducted a prospective case-matched study to compare outcomes of elective laparoscopic colorectal surgery in obese and nonobese patients.
Sixty-two consecutive nonselected obese patients (body mass index > or =30 kg/m(2)) were matched with 118 nonobese patients. Postsurgical mortality and morbidity were defined as in-hospital death and complications.
Cardiopulmonary comorbidities were significantly more frequent in obese compared with nonobese patients (44% vs 24%, P < .01). Obesity was significantly associated with increased mean operating time (268 +/- 74 min vs 232 +/- 59 min, P < .001), and conversion rate (32% vs 14%, P < .01). The mortality rate was nil. The overall postsurgical morbidity rate (31% vs 19%, P = not significant) and mean hospital stay (11 +/- 10 days vs 9 +/- 8 days, P = not significant) were similar in obese and nonobese patients.
The results of this large case-matched study suggest that laparoscopic approach for colorectal surgery is feasible and safe in obese patients.
由于有人提出肥胖患者术后发病和死亡风险可能更高，我们进行了一项前瞻性病例对照研究，以比较肥胖和非肥胖患者择期腹腔镜结直肠手术的结果。
连续选取62例未经筛选的肥胖患者（体重指数≥30kg/m²）与118例非肥胖患者进行匹配。术后死亡率和发病率定义为住院死亡和并发症。
与非肥胖患者相比，肥胖患者心肺合并症明显更常见（44%对24%，P<.01）。肥胖与平均手术时间延长（268±74分钟对232±59分钟，P<.001）和中转率升高（32%对14%，P<.01）显著相关。死亡率为零。肥胖和非肥胖患者的总体术后发病率（31%对19%，P无统计学意义）和平均住院时间（11±10天对9±8天，P无统计学意义）相似。
这项大型病例对照研究的结果表明，腹腔镜结直肠手术方法在肥胖患者中是可行且安全的。
