Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
Asian J Surg. 2023 Feb;46(2):829-833. doi: 10.1016/j.asjsur.2022.08.085. Epub 2022 Sep 9.
We aimed to evaluate associations between abdominal fat distribution (AFD) parameters and incisional hernia (IH) in patients who underwent transumbilical single-port laparoscopic surgery (SPLS) for gynecological disease.
Medical records of 2116 patients who underwent SPLS for gynecological disease at Daejeon St. Mary's Hospital between March 2014 and February 2021 were reviewed. Among 21 (1.0%) patients who developed IH requiring surgical treatment after SPLS, 18 had preoperative abdominopelvic computed tomography (CT) images. As a control group, we randomly selected 72 patients who did not develop IH and who had undergone preoperative abdominopelvic CT scan, matched to test patients by type of surgery. Total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), visceral-to-subcutaneous fat ratio (VSR), and waist circumference (WC) were measured at the level of the third lumbar vertebral body on the preoperative abdominopelvic CT images, using National Institutes of Health (NIH) ImageJ version 1.53 k.
Receiver operating curve analysis showed that VFA has the highest predictive value for IH among AFD parameters (AUC = 0.749, 95% CI 0.630-0.869, p < 0.001). Univariate analysis showed that age, BMI, hypertension, dyslipidemia, TFA, VFA, VSR and WC were significant factors for IH. In multivariate analysis, only high VFA was identified as an independent risk factor for IH (HR 6.18, 95% CI 1.13-33.87, p = 0.04), whereas BMI, TFA, SFA, VSR, and WC failed to show statistical significance.
We could find high VFA as an independent risk factor of IH in patients who underwent SPLS for gynecologic disease.
本研究旨在评估接受经脐单孔腹腔镜手术（SPLS）治疗妇科疾病的患者，其腹型脂肪分布（AFD）参数与切口疝（IH）的相关性。
回顾性分析 2014 年 3 月至 2021 年 2 月期间在大田圣母医院接受 SPLS 治疗妇科疾病的 2116 例患者的病历资料。在 21 例（1.0%）接受 SPLS 治疗后发生需要手术治疗的 IH 的患者中，18 例患者术前有腹盆部 CT 图像。作为对照组，我们随机选择了 72 例未发生 IH 且接受过术前腹盆部 CT 扫描的患者，通过手术类型与试验组进行匹配。在术前腹盆部 CT 图像的第三腰椎水平测量总脂肪面积（TFA）、内脏脂肪面积（VFA）、皮下脂肪面积（SFA）、内脏-皮下脂肪比（VSR）和腰围（WC），使用 NIH ImageJ 版本 1.53k 进行测量。
受试者工作特征曲线分析显示，在 AFD 参数中，VFA 对 IH 具有最高的预测价值（AUC=0.749，95%CI 0.630-0.869，p<0.001）。单因素分析显示，年龄、BMI、高血压、血脂异常、TFA、VFA、VSR 和 WC 是 IH 的显著因素。多因素分析显示，只有高 VFA 被确定为 IH 的独立危险因素（HR 6.18，95%CI 1.13-33.87，p=0.04），而 BMI、TFA、SFA、VSR 和 WC 则没有统计学意义。
我们发现 VFA 升高是妇科疾病接受 SPLS 治疗的患者发生 IH 的独立危险因素。
