Tuveri Massimiliano, Borsezio Valentina, Calò Pietro Giorgio, Medas Fabio, Tuveri Augusto, Nicolosi Angelo
Department of General and Vascular Surgery, Sant'Elena Clinic, Quartu Sant'Elena, Cagliari, Italy.
J Laparoendosc Adv Surg Tech A. 2009 Dec;19(6):735-40. doi: 10.1089/lap.2008.0301.
The aim of this study was to assess retrospectively the results of laparoscopic cholecystectomy (LC) performed in obese patients at our institution with the traditional technique and with the fundus-first (FF) technique.
We performed a retrospective analysis of 194 obese patients that underwent LC between 1994 and December 2007 at our institution. Surgical techniques were compared with respect to operative times, conversion to open cholecystectomy, postoperative complications, mortality, and length of postoperative stay.
In the reviewed period, LC was performed in 113 (58.2%) patients with obesity type I (OTI), 55 (28.3%) patients with obesity type II (OTII), and 26 (13.5%) patients with obesity type III (OTIII). None of the differences among obese groups treated with the two techniques were statistically significant, with the exception of the lower operative times in the OTIII patients treated with the FFLC. The median operating time in the OTIII group was, respectively, 90 minutes for traditional LC and 65 (range, 45-130) for FFLC (P < 0.05).
This study achieved to conclude that LC in the obese is a safe, feasible, and efficient operation, but remains a demanding procedure even in experienced hands. FFLC can support the traditional LC in the treatment of obese patients, yielding a complication rate comparable with the traditional technique. In our study, it significantly reduced the operative time in OTIII patients, simplifying all the intra-abdominal maneuvers and the gallbladder dissection.
本研究的目的是回顾性评估在我们机构采用传统技术和先处理胆囊底部（FF）技术对肥胖患者进行腹腔镜胆囊切除术（LC）的结果。
我们对1994年至2007年12月在我们机构接受LC的194例肥胖患者进行了回顾性分析。比较了两种手术技术在手术时间、中转开腹胆囊切除术、术后并发症、死亡率和术后住院时间方面的情况。
在回顾期间，113例（58.2%）I型肥胖（OTI）患者、55例（28.3%）II型肥胖（OTII）患者和26例（13.5%）III型肥胖（OTIII）患者接受了LC。除了采用FF-LC治疗的OTIII患者手术时间较短外，两种技术治疗的肥胖组之间的差异均无统计学意义。OTIII组传统LC的中位手术时间分别为90分钟，FF-LC为65分钟（范围45 - 130分钟）（P < 0.05）。
本研究得出结论，肥胖患者的LC是一种安全、可行且有效的手术，但即使在经验丰富的医生手中仍是一项具有挑战性的操作。FF-LC在肥胖患者的治疗中可辅助传统LC，并发症发生率与传统技术相当。在我们的研究中，它显著缩短了OTIII患者的手术时间，简化了所有腹腔内操作和胆囊剥离。
