Sahakyan Mushegh A, Røsok Bård Ingvald, Kazaryan Airazat M, Barkhatov Leonid, Lai Xiaoran, Kleive Dyre, Ignjatovic Dejan, Labori Knut Jørgen, Edwin Bjørn
Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway; Department of Surgery No1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia.
Department of HPB Sugery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Surgery. 2016 Nov;160(5):1271-1278. doi: 10.1016/j.surg.2016.05.046. Epub 2016 Aug 3.
Obesity is known as a risk factor for intra- and postoperative complications in pancreatic operation. However, the operative outcomes in obese patients undergoing laparoscopic distal pancreatectomy remain unclear.
A total number of 423 patients underwent laparoscopic distal pancreatectomy at Oslo University Hospital-Rikshospitalet from April 1997 to December 2015. Patients were categorized into 3 groups based on the body mass index: normal weight (18.5-24.9 kg/m), overweight (25-29.9 kg/m), and obese (≥30 kg/m). After excluding underweight patients, 402 patients were enrolled in this study.
Obese patients had significantly longer operative time and increased blood loss compared with overweight and normal weight patients (190 [61-480] minutes vs 158 [56-520] minutes vs 153 [29-374] minutes, P = .009 and 200 [0-2,800] mL vs 50 [0-6250] mL vs 90 [0-2,000] mL, P = .01, respectively). A multiple linear regression analysis identified obesity as predictive of prolonged operative time and increased blood loss during laparoscopic distal pancreatectomy. The rates of clinically relevant pancreatic fistula and severe complications (≥grade III by Accordion classification) were comparable in the 3 groups (P = .23 and P = .37, respectively). A multivariate logistic regression model did not demonstrate an association between obesity and postoperative morbidity (P = .09). The duration of hospital stay was comparable in the 3 groups (P = .13).
In spite of longer operative time and greater blood loss, laparoscopic distal pancreatectomy in obese patients is associated with satisfactory postoperative outcomes, similar to those in normal weight and overweight patients. Hence, laparoscopic distal pancreatectomy should be equally considered both in obese and nonobese patients.
肥胖被认为是胰腺手术术中及术后并发症的一个风险因素。然而,肥胖患者接受腹腔镜远端胰腺切除术的手术结果仍不明确。
1997年4月至2015年12月期间,共有423例患者在奥斯陆大学医院里克斯胡斯医院接受了腹腔镜远端胰腺切除术。根据体重指数将患者分为3组:正常体重(18.5 - 24.9kg/m²)、超重(25 - 29.9kg/m²)和肥胖(≥30kg/m²)。排除体重过轻的患者后,本研究纳入了402例患者。
与超重和正常体重患者相比,肥胖患者的手术时间明显更长,失血量更多(分别为190[61 - 480]分钟 vs 158[56 - 520]分钟 vs 153[29 - 374]分钟,P = 0.009;以及200[0 - 2800]mL vs 50[0 - 6250]mL vs 90[0 - 2000]mL,P = 0.01)。多元线性回归分析确定肥胖是腹腔镜远端胰腺切除术手术时间延长和失血量增加的预测因素。3组中临床相关胰瘘和严重并发症(根据手风琴分类法≥Ⅲ级)的发生率相当(分别为P = 0.23和P = 0.37)。多因素逻辑回归模型未显示肥胖与术后并发症之间存在关联(P = 0.09)。3组的住院时间相当(P = 0.13)。
尽管肥胖患者的手术时间更长、失血量更多,但腹腔镜远端胰腺切除术的术后结果令人满意,与正常体重和超重患者相似。因此,肥胖和非肥胖患者均应同样考虑行腹腔镜远端胰腺切除术。