Aytac Erman, Turina Matthias, Gorgun Emre, Stocchi Luca, Remzi Feza H, Costedio Meagan M
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland Clinic Main Campus Mail Code A30, 9,500 Euclid Ave., Cleveland, OH, 44195, USA.
Surg Endosc. 2014 Oct;28(10):2884-9. doi: 10.1007/s00464-014-3542-6. Epub 2014 May 23.
Obese patients pose additional operative technical difficulties, and it is unclear if the outcomes of single-port colorectal surgery are equivalent to those of conventional laparoscopy in such patients. The aim of this study was to compare perioperative variables and short-term outcomes of single-port versus conventional laparoscopy in obese patients undergoing colorectal surgery.
Obese patients (BMI ≥ 30 kg/m(2)) undergoing single-port laparoscopic colorectal resections between March 2009 and September 2012 were case matched 1:1 with obese counterparts undergoing conventional (multi-port) laparoscopic surgery based on diagnosis and operation type.
Thirty-seven patients who underwent single-port surgery were matched with 37 conventional laparoscopic counterparts. Male gender predominated in the single-port group (26 vs 15, p = 0.02). The number of patients with a history of previous abdominal operations (17 vs 13, p = 0.48) and ASA score (3 vs 2, p = 0.6) were similar between the groups. No differences were observed with respect to conversion rate (2 vs 5, p = 0.43), operative time (146 vs 150 min, p = 0.48), estimated blood loss (159 vs 183 ml, p = 0.99), time to first flatus (3 vs 3 days, p = 0.91), time to first bowel movement (3 vs 4 days, p = 0.62), length of hospital stay (7 vs 6 days, p = 0.37), or reoperation (2 vs 1, p > 0.99), and readmission rates (2 vs 2, p > 0.99). There were no deaths.
For obese patients undergoing colorectal resections, single-port laparoscopy appears to be as safe and effective as conventional laparoscopy.
肥胖患者会带来额外的手术技术难题，目前尚不清楚单孔结直肠手术在这类患者中的效果是否等同于传统腹腔镜手术。本研究的目的是比较肥胖患者接受结直肠手术时单孔与传统腹腔镜手术的围手术期变量及短期结局。
2009年3月至2012年9月期间接受单孔腹腔镜结直肠切除术的肥胖患者（BMI≥30kg/m²），根据诊断和手术类型，与接受传统（多孔）腹腔镜手术的肥胖患者进行1:1病例匹配。
37例行单孔手术的患者与37例传统腹腔镜手术患者相匹配。单孔组男性居多（26例对15例，p = 0.02）。两组间既往腹部手术史患者数量（17例对13例，p = 0.48）和美国麻醉医师协会（ASA）评分（3分对2分，p = 0.6）相似。在中转率（2例对5例，p = 0.43）、手术时间（146分钟对150分钟，p = 0.48）、估计失血量（159毫升对183毫升，p = 0.99）、首次排气时间（3天对3天，p = 0.91）、首次排便时间（3天对4天，p = 0.62）、住院时间（7天对6天，p = 0.37）、再次手术（2例对1例，p＞0.99）及再入院率（2例对2例，p＞0.99）方面未观察到差异。无死亡病例。
对于接受结直肠切除术的肥胖患者，单孔腹腔镜手术似乎与传统腹腔镜手术一样安全有效。
