Department of Surgery, Bronx-Lebanon Hospital, Albert Einstein College of Medicine, 1650 Selwyn Ave, Suite 4E, Bronx, NY 10457, USA.
Surg Endosc. 2012 Apr;26(4):964-9. doi: 10.1007/s00464-011-1978-5. Epub 2011 Oct 20.
Laparoscopic cholecystectomy (LC) is the standard of care for gallstone disease. Some cases will be converted to open surgery and others will have complications, both leading to worse outcomes. The purpose of this study was to evaluate whether an increased body mass index (BMI) is associated with increased rates of conversion or complication.
A retrospective chart review of 1,027 patients who underwent an attempted LC between January 2006 and December 2009 was performed. Patients were divided into five groups depending on their BMI: 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40. The primary endpoints were conversion rates, complication rates, and postoperative length of stay (LOS). Multivariate logistic regression was used to identify independent risk factors for worse outcomes.
There were 211 (20.5%), 325 (31.6%), 268 (26.1%), 135 (13.1%), and 88 (8.6%) patients in the groups with BMI values of 18.5-24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40, respectively. Seventy-three patients (7.1%) required conversion to open surgery, and 64 patients (6.2%) developed complications. The rate of conversion was similar amongst all the BMI groups (P = 0.366), as was the rate of complication (P = 0.483). Mean (± SD) postoperative LOS was 1.74 ± 3.87 days, and there was no difference between the BMI groups (P = 0.596). Male gender and emergent cholecystectomy were independent predictors of increased conversions and complications. Diabetes was a risk factor for conversion, whereas age >65 years was a risk factor for complications.
Increased BMI was not associated with worse outcomes after LC. Compared with normal weight patients, obese and even morbidly obese patients have no increased risk of conversion to open surgery, nor is there an increased risk of perioperative complications. Obese and morbidly obese patients who require a cholecystectomy should be considered in the same category as normal weight patients, and LC should be the standard of care.
腹腔镜胆囊切除术（LC）是治疗胆石病的标准方法。有些病例会转为开放性手术，有些则会出现并发症，这两种情况都会导致预后较差。本研究的目的是评估体重指数（BMI）增加是否与转换率或并发症增加有关。
对 2006 年 1 月至 2009 年 12 月期间接受尝试性 LC 的 1027 例患者进行了回顾性图表审查。根据 BMI 将患者分为五组：18.5-24.9、25-29.9、30-34.9、35-39.9 和≥40。主要终点是转化率、并发症发生率和术后住院时间（LOS）。采用多变量逻辑回归确定不良结局的独立危险因素。
BMI 值为 18.5-24.9、25-29.9、30-34.9、35-39.9 和≥40 的患者分别为 211 例（20.5%）、325 例（31.6%）、268 例（26.1%）、135 例（13.1%）和 88 例（8.6%）。73 例（7.1%）需要转为开放性手术，64 例（6.2%）发生并发症。所有 BMI 组的转化率相似（P=0.366），并发症发生率也相似（P=0.483）。术后平均 LOS 为 1.74±3.87 天，BMI 组之间无差异（P=0.596）。男性和急症胆囊切除术是转化率和并发症增加的独立预测因素。糖尿病是转化的危险因素，而年龄>65 岁是并发症的危险因素。
BMI 增加与 LC 后不良结局无关。与正常体重患者相比，肥胖甚至病态肥胖患者中转开腹手术的风险没有增加，围手术期并发症的风险也没有增加。需要胆囊切除术的肥胖和病态肥胖患者应与正常体重患者归为同一类别，LC 应作为标准治疗方法。
