Tandon A, Sunderland G, Nunes Q M, Misra N, Shrotri M
Aintree University Hospital , Liverpool , UK.
Royal Liverpool & Broadgreen University Hospitals NHS Trust , UK.
Ann R Coll Surg Engl. 2016 May;98(5):329-33. doi: 10.1308/rcsann.2016.0125.
Symptomatic gall stones may require laparoscopic cholecystectomy (LC), which is one of the most commonly performed general surgical operations in the western world. Patients with a high body mass index (BMI) are at increased risk of having gall stones, and are often considered at high risk of surgical complications due to their increased BMI. We believe that day case surgery could nevertheless have significant benefits in terms of potential cost savings and patient satisfaction in this population. We therefore compared the outcomes of day case patients undergoing LC stratified by BMI, with a specific focus on the safety and success of the procedure in obese and morbidly obese groups.
We reviewed a database of day case procedures performed between January 2004 and December 2012, including all patients with symptomatic gall stone disease who underwent LC. The patients were divided in four BMI groups: less than 25 kg/m(2), 25-29 kg/m(2), 30-39 kg/m(2) and 40 kg/m(2) or above.
The overall success rate for day case surgery was 78%. There were no significant differences in rates of intra-abdominal collection or readmission with increasing BMI. However, increasing BMI was associated with a significant increase in the rate of wound infection.
LC in patients with a high BMI is safe and can be performed effectively as a day case procedure.
有症状的胆结石可能需要进行腹腔镜胆囊切除术（LC），这是西方世界最常开展的普通外科手术之一。体重指数（BMI）较高的患者患胆结石的风险增加，并且由于其BMI增加，通常被认为手术并发症风险较高。我们认为，日间手术对于该人群在潜在成本节约和患者满意度方面可能具有显著益处。因此，我们比较了按BMI分层的接受LC的日间手术患者的结局，特别关注肥胖和病态肥胖组手术的安全性和成功率。
我们回顾了2004年1月至2012年12月期间进行的日间手术数据库，包括所有患有症状性胆结石疾病并接受LC的患者。患者分为四个BMI组：小于25kg/m²、25 - 29kg/m²、30 - 39kg/m²以及40kg/m²或更高。
日间手术的总体成功率为78%。随着BMI增加，腹腔内积液或再次入院率无显著差异。然而，BMI增加与伤口感染率显著增加相关。
高BMI患者的LC是安全的，并且可以作为日间手术有效进行。
