George Arvin K, Rothwax Jason T, Herati Amin S, Srinivasan Arun K, Rais-Bahrami Soroush, Shah Paras, Waingankar Nikhil, Saluja Sandeep S, Richstone Lee, Kavoussi Louis R
The Arthur Smith Institute for Urology, Hofstra North Shore-Long Island Jewish School of Medicine , New Hyde Park, New York.
J Endourol. 2015 Sep;29(9):1011-7. doi: 10.1089/end.2014.0725. Epub 2015 Jul 13.
Increased body mass index (BMI) has been shown to have inferior perioperative outcomes in patients undergoing laparoscopic partial nephrectomy (LPN). The aim of this study was to determine the differences in perioperative outcomes for patients undergoing LPN in normal, overweight, and obese persons using established BMI risk categories.
A retrospective review of 488 patients undergoing LPN was performed stratifying patients according to BMI of <25 kg/m(2), 25 to 30 kg/m(2), and >30 kg/m(2). The analysis of variance test, chi-square analysis, and bivariate regression models were used to compare comorbidities and perioperative outcomes among the groups.
One hundred and eighty nine of 369 patients were identified as being obese. Obese patients were found to have a significantly higher American Society of Anesthesiologists class (2.4 vs 2.1) than normal weight patients (P=0.03). No significant differences were demonstrated in estimated blood loss, operative time, transfusion requirement, or rate of conversion between the groups. In addition, there was no significant difference in cardiovascular, pulmonary, thromboembolic, or infectious complications between the groups. Obesity was significantly associated with bleeding necessitating angioembolization (P=0.033).
LPN demonstrates equivalent perioperative outcomes in normal, overweight, and obese patients. The minimally invasive approach achieves equivalent outcomes in patients undergoing major abdominal surgery although further studies of alternate procedures are needed to validate our findings.
体重指数（BMI）升高已被证明会使接受腹腔镜肾部分切除术（LPN）的患者围手术期结果较差。本研究的目的是使用既定的BMI风险类别，确定正常、超重和肥胖患者接受LPN时围手术期结果的差异。
对488例接受LPN的患者进行回顾性研究，根据BMI<25 kg/m²、25至30 kg/m²和>30 kg/m²对患者进行分层。采用方差分析、卡方分析和双变量回归模型比较各组之间的合并症和围手术期结果。
369例患者中有189例被确定为肥胖。发现肥胖患者的美国麻醉医师协会分级（2.4对2.1）显著高于正常体重患者（P=0.03）。各组之间在估计失血量、手术时间、输血需求或中转率方面未显示出显著差异。此外，各组之间在心血管、肺部、血栓栓塞或感染并发症方面也没有显著差异。肥胖与需要进行血管栓塞的出血显著相关（P=0.033）。
LPN在正常、超重和肥胖患者中显示出相似的围手术期结果。尽管需要进一步研究替代手术来验证我们的发现，但微创方法在接受大型腹部手术的患者中取得了相似的结果。
