Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, Universidade de Santa Cruz do Sul, Santa Cruz do Sul, Brazil.
World J Surg. 2010 Dec;34(12):2960-8. doi: 10.1007/s00268-010-0756-1.
The new global epidemic, overweight and obesity, has a significant role in the etiology of liver tumors. However, the impact of body weight on the outcome after liver resection is unknown.
We carried out a prospective study of 684 patients who underwent liver resections. Patients were stratified according their body mass index (BMI) as follows: normal (<25 kg/m(2)) (52%), overweight (25-29 kg/m(2)) (34%), and obese (≥30 kg/m(2)) (14%), and according to the extent of resection, as either minor or major hepatectomy. Preoperative and intraoperative characteristics and outcomes were prospectively studied. The Dindo-Clavien classification of morbidity was used.
Overall postoperative morbidity and morbidity rates were not influenced by BMI. Pulmonary complications were significantly more frequent in obese patients irrespective of the extent of resection. During major resection obese had longer pedicular clamping and more frequently required blood transfusion. After major resection, major morbidity (Dindo-Clavien grade III or more) was more frequent in obese (57%) and overweight (54%) patients than in patients of normal body weight (35%; P < 0.05), including a higher rate of respiratory complications and ascites and longer intensive care unit (ICU) and hospital stays. Obesity and overweight were independent predictors of major morbidity (OR 2.6, 95% CI 1.2-5.8 and OR 1.9, 95% CI 1.2-3.2, respectively), and obesity was a predictor of the need for blood transfusion (OR 3.3, 95% CI 1.4-7.9) after major resections.
Obese and overweight patients are at increased risk of potentially life-threatening morbidity after major hepatic resections. Because the risk of mortality is not increased significantly, there is no justification for a compromise in the indication or extent of surgery.
新的全球流行病，超重和肥胖，在肝脏肿瘤的病因学中起着重要作用。然而，体重对肝切除术后结果的影响尚不清楚。
我们对 684 例接受肝切除术的患者进行了前瞻性研究。根据体重指数（BMI）将患者分层：正常（<25 kg/m2）（52%）、超重（25-29 kg/m2）（34%）和肥胖（≥30 kg/m2）（14%），并根据肝切除的范围，分为小肝切除术或大肝切除术。前瞻性研究了术前和术中的特征和结果。使用 Dindo-Clavien 并发症分类。
总体术后发病率和发病率不受 BMI 的影响。无论切除范围如何，肥胖患者肺部并发症的发生率明显更高。在大肝切除术中，肥胖患者的肝蒂夹闭时间更长，更常需要输血。大肝切除术后，肥胖（57%）和超重（54%）患者的主要并发症（Dindo-Clavien 分级 III 级或更高级别）比体重正常患者（35%）更常见（P<0.05），包括更高的呼吸并发症和腹水发生率以及更长的重症监护病房（ICU）和住院时间。肥胖和超重是大肝切除术后主要并发症的独立预测因素（OR 2.6，95%CI 1.2-5.8 和 OR 1.9，95%CI 1.2-3.2），肥胖是大肝切除术后输血的预测因素（OR 3.3，95%CI 1.4-7.9）。
肥胖和超重患者在接受大肝切除术后发生潜在危及生命的并发症的风险增加。由于死亡率没有显著增加，因此没有理由在手术指征或范围上妥协。
