Wang Haiqing, Yang Jian, Zhang Xiaowu, Yan Lunan, Yang Jiayin
Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
PLoS One. 2014 Jun 10;9(6):e99281. doi: 10.1371/journal.pone.0099281. eCollection 2014.
Although many studies on evaluating the safety of liver resection in obese patients have been conducted, the results remain contradictory. The aim of our study was to investigate the safety of overweight and obese patients undergoing liver resection for hepatitis B-related hepatocellular carcinoma in a large sample.
In a retrospective cohort with 1543 hepatitis B-related hepatocellular carcinoma patients, the subjects were stratified into four groups according to their body mass index(BMI): obesity(BMI≥28), overweight(BMI:24.0-27.9), normal weight(BMI:18.5-23.9) and underweight(BMI<18.5). The Dindo-Clavien classification system was used for grading complications. Clinical characteristics and operative outcomes were compared among the four groups. Risk factors for postoperative complications were evaluated by multivariate analysis.
According to the category criteria of the Working Group on Obesity in China (WGOC) criteria, 73(4.7%) obese, 412(26.7%) overweight, 982(63.6%) normal weight and 76(4.9%) underweight patients were included in our cohort. Overweight and obese patients had more preoperative comorbidities such as hypertension(P<0.001). Mortality, total complications and complications classified by Clavien system were similar among the four groups except that the underweight patients had fewer total complications. However, postoperative wound complication was more common in overweight and obese patients(6.3% vs 2.5%,P<0.001,11.0% vs 2.5%,P = 0.001). Multivariate analysis revealed that BMI was not an independently significant factor for postoperative complications.
Liver resection for obese and overweight patients is safe and BMI itself is not a risk factor for mortality and morbidity.
尽管已经开展了许多关于评估肥胖患者肝切除安全性的研究，但结果仍相互矛盾。我们研究的目的是在大样本中调查超重和肥胖患者接受乙型肝炎相关肝细胞癌肝切除的安全性。
在一个包含1543例乙型肝炎相关肝细胞癌患者的回顾性队列中，根据体重指数（BMI）将受试者分为四组：肥胖（BMI≥28）、超重（BMI：24.0 - 27.9）、正常体重（BMI：18.5 - 23.9）和体重过轻（BMI<18.5）。采用Dindo-Clavien分类系统对并发症进行分级。比较四组患者的临床特征和手术结果。通过多变量分析评估术后并发症的危险因素。
根据中国肥胖问题工作组（WGOC）标准的分类标准，我们的队列中包括73例（4.7%）肥胖患者、412例（26.7%）超重患者、982例（63.6%）正常体重患者和76例（4.9%）体重过轻患者。超重和肥胖患者术前合并症更多，如高血压（P<0.001）。除体重过轻患者的总并发症较少外，四组患者的死亡率、总并发症以及根据Clavien系统分类的并发症相似。然而，超重和肥胖患者术后伤口并发症更为常见（6.3%对2.5%，P<0.001；11.0%对2.5%，P = 0.001）。多变量分析显示，BMI不是术后并发症的独立显著因素。
肥胖和超重患者的肝切除是安全的，BMI本身不是死亡率和发病率的危险因素。
