Department of Surgery, Kurashiki Central Hospital, Okayama, Japan.
Department of Surgery, Kurashiki Central Hospital, Okayama, Japan.
Asian J Surg. 2019 Jan;42(1):180-188. doi: 10.1016/j.asjsur.2017.10.002. Epub 2017 Dec 20.
Obesity is generally reported to increase the risk of surgical complications. There have been few reports of laparoscopic hepatectomy (LH) in obese patients. The purpose of this study was to compare the safety and efficacy of (1) LH versus open hepatectomy (OH) in obese patients and (2) LH in obese patients versus LH in non-obese patients.
We introduced LH at our institution in April 2014. LH was performed in 63 obese patients and 108 non-obese patients from April 2014 to May 2017. OH was performed in 79 obese patients from January 2010 to May 2017. This study retrospectively compared the short-term outcomes of the LH obese group with those of the OH obese group and the LH non-obese group.
In patient characteristics, the LH obese group included a significantly higher percentage of patients with liver cirrhosis than the OH obese group. The LH obese group had fewer patients with a history of abdominal surgery but more with liver cirrhosis than the LH non-obese group. For short-term outcomes, the LH obese group had significantly less blood loss, fewer intraoperative transfusions, fewer positive surgical margins, and shorter postoperative hospital stays than the OH obese group. In contrast, only operation time was significantly different (longer) in the LH obese group than in the LH non-obese group. There were no significant differences in morbidity or mortality between the LH obese group and either the OH obese or the LH non-obese groups.
LH in obese patients is safe and effective.
肥胖通常被认为会增加手术并发症的风险。肥胖患者行腹腔镜肝切除术（LH）的报道较少。本研究旨在比较（1）肥胖患者行 LH 与开腹肝切除术（OH）的安全性和疗效，以及（2）肥胖患者行 LH 与非肥胖患者行 LH 的安全性和疗效。
我们于 2014 年 4 月在我院开展 LH。2014 年 4 月至 2017 年 5 月，我们对 63 例肥胖患者和 108 例非肥胖患者进行了 LH。2010 年 1 月至 2017 年 5 月，我们对 79 例肥胖患者进行了 OH。本研究回顾性比较了 LH 肥胖组与 OH 肥胖组和 LH 非肥胖组的短期结果。
在患者特征方面，LH 肥胖组中肝硬化患者的比例明显高于 OH 肥胖组。LH 肥胖组中既往有腹部手术史的患者较少，但肝硬化患者较多。在短期结果方面，LH 肥胖组出血量明显较少，术中输血较少，切缘阳性率较低，术后住院时间较短。相比之下，LH 肥胖组的手术时间明显长于 LH 非肥胖组。LH 肥胖组的发病率和死亡率与 OH 肥胖组或 LH 非肥胖组均无显著差异。
肥胖患者行 LH 安全有效。
