Wysham Weiya Z, Kim Kenneth H, Roberts Jared M, Sullivan Stephanie A, Campbell Sukhkamal B, Roque Dario R, Moore Dominic T, Gehrig Paola A, Boggess John F, Soper John T, Huh Warner K
Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC.
Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC; Lineberger Clinical Cancer Center, University of North Carolina School of Medicine, Chapel Hill, NC.
Am J Obstet Gynecol. 2015 Jul;213(1):33.e1-33.e7. doi: 10.1016/j.ajog.2015.01.033. Epub 2015 Jan 28.
Robotic gynecological surgery is feasible in obese patients, but there remain concerns about the safety of this approach because the positioning required for pelvic surgery can exacerbate obesity-related changes in respiratory physiology. The objective of our study was to evaluate pulmonary and all-cause complication rates in obese women undergoing robotic gynecological surgery and to assess variables that may be associated with complications.
A retrospective chart review was performed on obese patients (body mass index of ≥30 kg/m(2)) who underwent robotic gynecological surgery at 2 academic institutions between 2006 and 2012. The primary outcome was pulmonary complications and the secondary outcome was all-cause complications. Univariate and multivariate logistic regression analyses were used to determine the associations between patient baseline variables, operative variables, ventilator parameters, and complications.
Of 1032 patients, 146 patients (14%) had any complication, whereas only 33 patients (3%) had a pulmonary complication. Median body mass index was 37 kg/m(2). Only age was significantly associated with a higher risk of pulmonary complications (P = .01). Older age, higher estimated blood loss, and longer case length were associated with a higher rate of all-cause complications (P = .0001, P < .0001, and P = .004, respectively). No other covariates were strongly associated with complications.
The vast majority of obese patients can successfully tolerate robotic gynecological surgery and have overall low complications rates and even lower rates of pulmonary complications. The degree of obesity was not predictive of successful robotic surgery and subsequent complications.
机器人妇科手术在肥胖患者中是可行的，但由于盆腔手术所需的体位可能会加剧肥胖相关的呼吸生理变化，因此人们对这种手术方式的安全性仍存在担忧。我们研究的目的是评估接受机器人妇科手术的肥胖女性的肺部并发症和全因并发症发生率，并评估可能与并发症相关的变量。
对2006年至2012年期间在2家学术机构接受机器人妇科手术的肥胖患者（体重指数≥30kg/m²）进行回顾性病历审查。主要结局是肺部并发症，次要结局是全因并发症。采用单因素和多因素逻辑回归分析来确定患者基线变量、手术变量、呼吸机参数与并发症之间的关联。
在1032例患者中，146例（14%）出现任何并发症，而只有33例（3%）出现肺部并发症。体重指数中位数为37kg/m²。只有年龄与肺部并发症风险较高显著相关（P = 0.01）。年龄较大、估计失血量较多和手术时间较长与全因并发症发生率较高相关（分别为P = 0.0001、P < 0.0001和P = 0.004）。没有其他协变量与并发症密切相关。
绝大多数肥胖患者能够成功耐受机器人妇科手术，总体并发症发生率较低，肺部并发症发生率甚至更低。肥胖程度并不能预测机器人手术的成功及后续并发症。
