Wallace Scott A, Mericli Alexander F, Taylor Peyton T, Drake David B
Department of Plastic Surgery, University of Virginia, Charlottesville, VA 22908, USA.
Ann Plast Surg. 2013 Jul;71(1):88-92. doi: 10.1097/SAP.0b013e31824143b7.
The current obesity epidemic poses significant challenges to surgical specialists striving to safely and effectively deliver medical care. In the United States, approximately 33.3% of men and 35.3% of women are classified as obese. Pelvic surgery, especially in patients with gynecological malignancies and those who require complex surgical procedures carries additional risk because of the increased technical difficulty posed by excess abdominal wall tissues and increased difficulty in providing and maintaining exposure of the appropriate pelvic anatomy. Simultaneous panniculectomy or abdominoplasty in selected patients may provide better access and visualization of the surgical field, reduce operative difficulty, and decrease perioperative morbidity. We retrospectively reviewed our experience in 15 patients undergoing panniculectomy or abdominoplasty in conjunction with gynecologic surgery. This review was conducted after approval by the local institutional review board. Complications were analyzed, and 2 (13%) of the 15 patients were found to have major complications. The only statistically significant finding for prediction of a negative outcome was an association of hypertension and advanced age with increased risk of postoperative transfusion (P < 0.02).
当前的肥胖流行给致力于安全有效地提供医疗服务的外科专家带来了重大挑战。在美国,约33.3%的男性和35.3%的女性被归类为肥胖。盆腔手术,尤其是妇科恶性肿瘤患者以及需要进行复杂手术的患者,由于腹壁组织过多增加了技术难度,以及在暴露和维持适当盆腔解剖结构方面难度加大,因而存在额外风险。对部分患者同时进行腹壁成形术或腹部整形术可能会改善手术视野的暴露和视野,降低手术难度,并减少围手术期发病率。我们回顾性分析了15例接受腹壁成形术或腹部整形术联合妇科手术患者的经验。本回顾性分析在获得当地机构审查委员会批准后进行。分析并发症情况,发现15例患者中有2例(13%)出现严重并发症。预测不良结局的唯一具有统计学意义的发现是高血压和高龄与术后输血风险增加相关(P<0.02)。