Ciavattini Andrea, Di Giuseppe Jacopo, Cecchi Stefano, Tsiroglou Dimitrios, Mancioli Francesca, Stevenazzi Guido, Tranquilli Andrea L, Litta Pietro
Woman's Health Sciences Department, Polytechnic University of Marche, Ancona, Italy.
Woman's Health Sciences Department, Polytechnic University of Marche, Ancona, Italy.
Eur J Obstet Gynecol Reprod Biol. 2014 Apr;175:49-53. doi: 10.1016/j.ejogrb.2013.12.035. Epub 2014 Jan 3.
To evaluate the feasibility, operative outcome and postoperative complications of laparoscopic gynaecologic surgery in patients aged 65 or more, with increased comorbidity and obesity.
The medical records of patients aged 65 or more with uterine or ovarian disease admitted to minimally invasive gynecologic surgery units from January 2009 to December 2011 were retrospectively analyzed in an observational cohort study. Surgical outcomes of the laparoscopic cohort (n=65) were compared with the outcomes of those who had laparotomy (n=67) at general gynecologic surgery units, and evaluated with respect to indication for surgery, medical comorbidity and obesity. Laparoscopic surgery was attempted in women who accepted minimally invasive management and who had no absolute contraindications to laparoscopy. Surgical inclusion criteria were benign and malignant uterine and adnexal pathologies; benign uterine pathologies when uterine size was less than 18 weeks' gestation or myoma smaller than 10cm; malignancies in apparent early-stage disease. There was no attempt to use laparoscopy for tumor debulking and cytoreductive surgery. Exclusion criteria were patients with emergency operations or a concomitant urogynecologic procedure. Data were analyzed using Student's t-test, the Mann-Whitney U test, χ(2) testing and the Fisher exact test.
Patients undergoing laparoscopy had a significantly shorter hospital stay (p<0.001), less intraoperative bleeding (p<0.001), less postoperative hemoglobin decline (p<0.001), less need for blood transfusions (p=0.007) and a generally lower incidence of complications compared to women who had laparotomy, regardless of medical comorbidity. Obese patients who had laparoscopy had significantly less intraoperative bleeding and a smaller postoperative hemoglobin drop; no adjunctive complication was observed. In patients over 70 (80 cases) the laparoscopic group (39 cases) maintained significantly less intraoperative bleeding (p<0.001) and a smaller hemoglobin drop (p<0.001) with respect to laparotomy, with few postoperative complications.
According to the results of the study, laparoscopic surgery appears feasible and safe in elderly patients, regardless of medical comorbidity and obesity.
评估65岁及以上、合并症增加且肥胖的患者进行腹腔镜妇科手术的可行性、手术效果及术后并发症。
在一项观察性队列研究中，对2009年1月至2011年12月入住微创妇科手术科室的65岁及以上患有子宫或卵巢疾病的患者的病历进行回顾性分析。将腹腔镜手术组（n = 65）的手术结果与普通妇科手术科室接受剖腹手术的患者（n = 67）的结果进行比较，并根据手术指征、内科合并症和肥胖情况进行评估。对接受微创治疗且无腹腔镜绝对禁忌症的女性尝试进行腹腔镜手术。手术纳入标准为子宫和附件的良性及恶性病变；子宫大小小于18周妊娠或肌瘤小于10cm时的良性子宫病变；明显早期疾病的恶性肿瘤。未尝试使用腹腔镜进行肿瘤减灭术和细胞减灭术。排除标准为急诊手术患者或同时进行泌尿妇科手术的患者。数据采用学生t检验、曼-惠特尼U检验、χ²检验和费舍尔精确检验进行分析。
与接受剖腹手术的女性相比，无论内科合并症情况如何，接受腹腔镜手术的患者住院时间显著缩短（p < 0.001），术中出血更少（p < 0.001），术后血红蛋白下降更少（p < 0.001），输血需求更少（p = 0.007），且并发症总体发生率更低。接受腹腔镜手术的肥胖患者术中出血显著更少，术后血红蛋白下降幅度更小；未观察到附加并发症。在70岁以上的患者（80例）中，腹腔镜手术组（39例）与剖腹手术组相比，术中出血显著更少（p < 0.001），血红蛋白下降幅度更小（p < 0.001），术后并发症较少。
根据研究结果，腹腔镜手术在老年患者中似乎是可行且安全的，无论其内科合并症和肥胖情况如何。
