Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Henri Mondor Hospital, Creteil, France.
HPB (Oxford). 2011 Feb;13(2):103-11. doi: 10.1111/j.1477-2574.2010.00252.x. Epub 2010 Dec 22.
Obesity has been associated with worse postoperative outcomes. No data are available regarding short-term results after liver resection (LR). The aim of this study was to analyse outcomes in obese patients (body mass index [BMI] > 30 kg/m(2) ) undergoing LR.
85 consecutive obese patients undergoing LR between 1998 and 2008 were matched on a ratio of 1:2 with 170 non-obese patients. Matching criteria were diagnosis, ASA score, METAVIR fibrosis score, extent of LR, and Child-Pugh score in patients with cirrhosis.
Operative time, blood loss and blood transfusions were similar in the two groups. Mortality was 2.4% in both groups. Morbidity was significantly higher in the obese group (32.9% vs. 21.2%; P= 0.041). However, only grade II morbidity was increased in obese patients (14.1% vs. 1.8%; P < 0.001) and this was mainly related to abdominal wall complications (8.2% vs. 2.4%; P= 0.046). No differences were encountered in terms of grade III or IV morbidity. The same results were observed in major LR and cirrhotic patients. When patients were stratified by BMI (<20, 20-25, 25-30 and >30 kg/m(2) ), progressive increases in overall and infectious morbidity were observed (5.6%, 22.4%, 23.7%, 32.9%, and 5.6%, 11.8%, 14.5%, 18.8%, respectively). Rates of grade III and IV morbidity did not change.
Obese patients have increased postoperative morbidity after LR in comparison with non-obese patients, but this is mainly related to minor abdominal wall complications. Severe morbidity rates and mortality are similar to those in non-obese patients, even in cirrhosis or after major LR.
肥胖与术后不良结局相关。目前尚无有关肝切除（LR）后短期结果的数据。本研究旨在分析肥胖患者（BMI＞30kg/m2）接受 LR 的结果。
1998 年至 2008 年间，85 例连续肥胖患者接受了 LR，按照 1：2 的比例与 170 例非肥胖患者进行了配对。配对标准为诊断、ASA 评分、METAVIR 纤维化评分、LR 范围和肝硬化患者的 Child-Pugh 评分。
两组的手术时间、出血量和输血量相似。两组的死亡率均为 2.4%。肥胖组的发病率明显较高（32.9%比 21.2%；P=0.041）。然而，肥胖患者仅出现 II 级发病率增加（14.1%比 1.8%；P＜0.001），这主要与腹壁并发症有关（8.2%比 2.4%；P=0.046）。未发现 III 级或 IV 级发病率的差异。在主要 LR 和肝硬化患者中也观察到了相同的结果。当按 BMI（＜20、20-25、25-30 和＞30kg/m2）对患者进行分层时，观察到总发病率和感染发病率逐渐增加（分别为 5.6%、22.4%、23.7%和 32.9%；以及 5.6%、11.8%、14.5%和 18.8%）。III 级和 IV 级发病率没有变化。
与非肥胖患者相比，肥胖患者在接受 LR 后术后发病率增加，但这主要与轻微的腹壁并发症有关。严重发病率和死亡率与非肥胖患者相似，即使在肝硬化或接受主要 LR 后也是如此。
