Louie Michelle, Toubia Tarek, Schiff Lauren D
Division of Minimally Invasive Gynecologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Curr Opin Obstet Gynecol. 2016 Aug;28(4):283-9. doi: 10.1097/GCO.0000000000000287.
The purpose is to review the key anatomical and physiological changes in obese patients and their effects on preoperative, intraoperative, and postoperative care and to highlight the best practices to safely extend minimally invasive approaches to obese patients and provide optimal surgical outcomes in this high-risk population.
Minimally invasive surgery is safe, feasible, and cost-effective for obese patients. Obesity is associated with anatomical and physiological changes in almost all organ systems, which necessitates a multimodal approach and an experienced, multidisciplinary team. Preoperative counseling, evaluation, and optimization of medical comorbidities are critical. The optimal minimally invasive approach is primarily determined by the patient's anatomy and pathology. Specific intraoperative techniques and modifications exist to maximize surgical exposure and panniculus management. Postoperatively, comprehensive medical management can help prevent common complications in obese patients, including hypoxemia, venous thromboembolism, acute kidney injury, hyperglycemia, and prolonged hospitalization.
Given significantly improved patient outcomes, minimally invasive approaches to gynecological surgery should be considered for all obese patients with particular attention given to specific perioperative considerations and appropriate referral to an experienced minimally invasive surgeon.
本文旨在回顾肥胖患者关键的解剖学和生理学变化，及其对术前、术中和术后护理的影响，并强调将微创方法安全扩展至肥胖患者并在此高危人群中提供最佳手术效果的最佳实践。
微创手术对肥胖患者而言安全、可行且具有成本效益。肥胖几乎与所有器官系统的解剖学和生理学变化相关，这就需要采用多模式方法并组建一支经验丰富的多学科团队。术前咨询、评估以及对合并症的优化治疗至关重要。最佳的微创方法主要由患者的解剖结构和病理状况决定。存在特定的术中技术和改进措施以最大化手术视野暴露和处理腹部赘肉。术后，全面的医疗管理有助于预防肥胖患者的常见并发症，包括低氧血症、静脉血栓栓塞、急性肾损伤、高血糖以及住院时间延长。
鉴于患者预后显著改善，对于所有肥胖患者均应考虑采用微创方法进行妇科手术，尤其要特别关注围手术期的具体注意事项，并适当地转诊至经验丰富的微创外科医生处。
