对于超级肥胖患者，腹腔镜单阶段胆胰转流并十二指肠转位术是否安全？
Is laparoscopic single-stage biliopancreatic diversion with duodenal switch safe in super morbidly obese patients?
作者信息
Rezvani Masoud, Sucandy Iswanto, Klar Amarita, Bonanni Fernando, Antanavicius Gintaras
机构信息
Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
Department of Surgery, Institute for Bariatric and Metabolic Surgery, Abington Memorial Hospital, Abington, Pennsylvania.
出版信息
Surg Obes Relat Dis. 2014 May-Jun;10(3):427-30. doi: 10.1016/j.soard.2013.10.004. Epub 2013 Oct 14.
BACKGROUND
It has been hypothesized that the morbidity and mortality of laparoscopic biliopancreatic diversion with duodenal switch (BPD-DS) are likely to increase with increasing body mass index (BMI), especially with BMI>50 kg/m(2). Therefore, a 2-stage approach to this procedure has been advocated in super morbidly obese patients. The authors hypothesized that a BMI ≥ 50 kg/m(2) does not significantly influence the morbidity and mortality perioperatively associated with this procedure.
METHODS
A retrospective analysis of all patients who underwent laparoscopic BPD-DS between January 2009 and September 2011 was performed. The patients were divided into 2 groups: patients with BMI<50 kg/m(2) and those with BMI>50 kg/m(2). Patient characteristics, perioperative variables, 30-day outcomes, and complications were analyzed and compared.
RESULTS
A total of 226 patients underwent laparoscopic BPD-DS. Mean patient age was 44.9 years (range: 20-72 yr). Male to female ratio was 59 to 170 patients (75% versus 25%), respectively. Mean BMI was 50.2 kg/m(2) (range: 37.2-68.8 kg/m(2)). A total of 127 patients had a BMI<50 kg/m(2) (Group 1), and 99 patients had a BMI ≥ 50 kg/m(2) (Group 2). The length of procedure in Groups 1 and 2 was 296 minutes and 287 minutes, respectively (P = .25). The rate of conversion to open BPD-DS was 1.5% in Group 1 and 3% in Group 2 (P = .65). Two leaks occurred in Group 1; no patient in Group 2 developed this complication. One patient in Group 2 developed pulmonary embolism. The rates of all other complications resulting in a longer length of stay were 11% in Group 1 and 8% in Group 2 (P = .50). The 30-day reoperation rate was 3% in Group 1 and 1% in Group 2 (P = .39). The mean length of stay was 3.97 days for Group 1 and 3.67 days for Group 2 (P = .34). No mortality occurred in this series.
CONCLUSION
In the present study, BMI ≥ 50 kg/m(2) did not increase intraoperative or postoperative complications at 30 days after laparoscopic PBD-DS. No significant differences were noted between patients with BMI ≥ 50 kg/m(2) and patients with BMI<50 kg/m(2). A single-stage laparoscopic BPD-DS procedure can be safely offered to the super morbidly obese patients.
背景
有假设认为，腹腔镜胆胰转流十二指肠转位术（BPD-DS）的发病率和死亡率可能会随着体重指数（BMI）的增加而上升，尤其是BMI>50kg/m²时。因此，对于超级肥胖患者，有人主张采用两阶段手术方法。作者假设BMI≥50kg/m²并不会显著影响该手术围手术期的发病率和死亡率。
方法
对2009年1月至2011年9月期间接受腹腔镜BPD-DS手术的所有患者进行回顾性分析。患者分为两组：BMI<50kg/m²的患者和BMI>50kg/m²的患者。分析并比较患者特征、围手术期变量、30天结局及并发症。
结果
共有226例患者接受了腹腔镜BPD-DS手术。患者平均年龄为44.9岁（范围：20 - 72岁）。男女比例分别为59例和170例患者（75%对25%）。平均BMI为50.2kg/m²（范围：37.2 - 68.8kg/m²）。共有127例患者BMI<50kg/m²（第1组），99例患者BMI≥50kg/m²（第2组）。第1组和第2组的手术时间分别为296分钟和287分钟（P = 0.25）。第1组中转开腹BPD-DS手术的比例为1.5%，第2组为3%（P = 0.65）。第1组发生2例渗漏；第2组无患者出现此并发症。第2组有1例患者发生肺栓塞。导致住院时间延长的所有其他并发症发生率在第1组为11%，在第2组为8%（P = 0.50）。第1组的30天再次手术率为3%，第2组为1%（P = 0.39）。第1组的平均住院时间为3.97天，第2组为3.67天（P = 0.34）。本系列中无死亡病例。
结论
在本研究中，BMI≥50kg/m²并未增加腹腔镜PBD-DS术后30天的术中或术后并发症。BMI≥50kg/m²的患者与BMI<50kg/m²的患者之间未发现显著差异。对于超级肥胖患者，可以安全地实施单阶段腹腔镜BPD-DS手术。
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