The Royal Bournemouth and Christchurch Hospitals NHS Trust, Urology Department, Bournemouth, UK.
BJU Int. 2012 Nov;110(9):1244-50. doi: 10.1111/j.1464-410X.2012.11094.x. Epub 2012 Apr 3.
What's known on the subject? and What does the study add? The literature yielded only four studies on the subject; however, no clear outcome can be taken from individual studies. This review adds a meta-analysis of these four studies to make the patient cohort larger and to allow for a greater understanding of the procedure in this select group of patients. • To compare the safety and efficacy of laparoscopic partial nephrectomy (LPN) in obese and non-obese patients. • We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to November 2011), EMBASE (1980 to November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings without language restriction for studies comparing LPN in obese and non-obese patients. • Four observational cohort studies were included for 256 obese patients compared with 403 non-obese patients who underwent LPN. • There was no difference in operative duration (mean difference [MD] 5.64, 95% confidence interval [CI]-3.80 to 15.09), warm ischaemic time (MD -1.04, 95% CI -2.68 to 0.59), estimated blood loss (MD 53.73, 95% CI 0.72-106.74) or hospital stay (MD -0.04, 95% CI -0.30 to 0.22). • There was no difference in complications in total (odds ratio [OR] 1.02, 95% CI 0.70-1.49), intraoperative complications (OR 0.68, 95% CI 0.30-1.53), or postoperative complications (OR 1.15, 95% CI 0.75-1.77). • The obese group had significantly more Clavien grade III complications (OR 3.95, 95% CI 1.36-11.42), despite the low absolute incidence, with 4.3% (11/256) in the obese group vs 1.5% (6/403) in the non-obese group. • Experienced laparoscopic surgeons can safely and efficiently perform PN for obese patients with comparable results to those of non-obese patients. • The likelihood of major (Clavien Classification ≥ III) complications is higher for the obese patient.
关于这个主题已知的内容是什么？以及这项研究增加了什么内容？文献中仅对该主题进行了四项研究；然而，从个体研究中无法得出明确的结论。本综述对这四项研究进行了荟萃分析，以使患者队列更大，并更好地了解该手术在这组特定患者中的应用。
比较肥胖和非肥胖患者腹腔镜部分肾切除术（LPN）的安全性和疗效。
我们检索了 Cochrane 对照试验中心注册库（CENTRAL）、MEDLINE（1966 年至 2011 年 11 月）、EMBASE（1980 年至 2011 年 11 月）、CINAHL、Clinicaltrials.gov、Google Scholar，以及会议论文集摘要，未对比较肥胖和非肥胖患者行 LPN 的研究设置语言限制，以查找相关研究。
纳入了四项观察性队列研究，共纳入 256 例肥胖患者和 403 例非肥胖患者，对他们进行了 LPN。
手术时间（均值差[MD]5.64，95%置信区间[CI]3.80 至 15.09）、热缺血时间（MD-1.04，95%CI-2.68 至 0.59）、估计失血量（MD53.73，95%CI0.72 至 106.74）或住院时间（MD-0.04，95%CI-0.30 至 0.22）方面，两组间均无差异。
总并发症（比值比[OR]1.02，95%CI0.70-1.49）、术中并发症（OR0.68，95%CI0.30-1.53）或术后并发症（OR1.15，95%CI0.75-1.77）方面，两组间也无差异。
尽管肥胖组的绝对发生率较低，但肥胖组的 Clavien 分级 III 级并发症明显更多（OR3.95，95%CI1.36-11.42），其发生率为 4.3%（11/256），而非肥胖组为 1.5%（6/403）。
经验丰富的腹腔镜外科医生可以安全有效地为肥胖患者施行 PN，其结果与非肥胖患者相似。
肥胖患者发生主要（Clavien 分级≥III 级）并发症的可能性更高。
