Department of Obstetrics and Gynecology, Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina, Chapel Hill, USA.
J Minim Invasive Gynecol. 2012 Nov-Dec;19(6):701-7. doi: 10.1016/j.jmig.2012.07.005.
To estimate the effect of body mass index (BMI) on several outcomes in laparoscopic hysterectomy, in particular in the extremes of obesity.
Retrospective cohort study (Canadian Task Force classification II-3).
Tertiary-care university-based teaching hospital.
Eight hundred thirty-four patients who underwent laparoscopic hysterectomy from January 2007 to October 2011.
Laparoscopic hysterectomy for benign indications.
Demographic, operative, and postoperative data were abstracted from medical records. The primary outcome was a composite index score that took into account operative time, nonsurgical operating room time, estimated blood loss, length of hospital stay, number of complications, and severity of complications according to the Dindo-Clavien classification. We individually examined elements of the composite index as a secondary outcome. Models were developed to assess the association of BMI with the composite index score and the components of the index, controlling for age, presence of diabetes, tobacco use, surgeon, type of hysterectomy (total vs supracervical), use of robotics, uterine weight, number of additional procedures performed, presence of adhesions requiring lysis, and deeply infiltrating endometriosis as potential confounders. Mean (SD) BMI was 31.4 (8.1). Mean (SD) uterine weight was 345 (388) g. Mean operative time was 150 (61) minutes. Increasing BMI was associated with a worse composite score (p < .01); longer operative time (p = .03), nonsurgical operating room time (p = .02), and total operating room time (p < .01); greater estimated blood loss (p < .01); and complication severity (p = .01).
These data suggest that there is a significant association of BMI with surgical outcomes in laparoscopic hysterectomy, and the effect is most pronounced in the morbidly obese. These patients may stand to gain the greatest differential benefit from a laparoscopic approach to surgery. However, they should be properly counseled about the challenge that obesity poses to the operation.
评估体重指数（BMI）对腹腔镜子宫切除术多种结局的影响，尤其是肥胖症的极端情况。
回顾性队列研究（加拿大任务组分类 II-3）。
三级保健大学附属医院。
2007 年 1 月至 2011 年 10 月间接受腹腔镜子宫切除术的 834 名患者。
良性适应证的腹腔镜子宫切除术。
从病历中提取人口统计学、手术和术后数据。主要结果是一个综合指数评分，考虑了手术时间、非手术手术室时间、估计失血量、住院时间、并发症数量和根据 Dindo-Clavien 分类的并发症严重程度。我们分别检查了综合指数的各个元素作为次要结果。建立模型来评估 BMI 与综合指数评分以及指数各组成部分的关联，控制年龄、糖尿病、吸烟、手术医生、子宫切除术类型（全子宫切除术与次全子宫切除术）、使用机器人、子宫重量、附加手术数量、粘连需要松解的存在以及深部浸润性子宫内膜异位症作为潜在混杂因素。平均（标准差）BMI 为 31.4（8.1）。平均（标准差）子宫重量为 345（388）g。平均手术时间为 150（61）分钟。BMI 的增加与较差的综合评分相关（p <.01）；手术时间延长（p =.03）、非手术手术室时间延长（p =.02）和总手术室时间延长（p <.01）；估计失血量增加（p <.01）；以及并发症严重程度（p =.01）。
这些数据表明，BMI 与腹腔镜子宫切除术的手术结局有显著关联，在病态肥胖患者中这种关联最为明显。这些患者可能从腹腔镜手术方法中获得最大的差异获益。然而，应向他们提供有关肥胖对手术带来的挑战的适当咨询。
