Suh Suk-Won
Department of Surgery, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 224-1, Heuk Seok-Dong, Dongjak-Ku, Seoul 156-755, Korea.
J Pers Med. 2022 Nov 13;12(11):1897. doi: 10.3390/jpm12111897.
As the number of obese patients requiring hepatic resection is increasing, efforts to understand their operative risk and determine proper perioperative management are necessary. A total of 175 patients who underwent hepatic resection between March 2015 and July 2021 were evaluated. The patients were divided into two groups by their body mass index (BMI) using the World Health Organization definition of obesity for Asians: obese patients (BMI ≥ 25 kg/m2, n = 84) and non-obese patients (BMI < 25 kg/m2, n = 91). The operative duration (195.7 ± 62.9 min vs. 176.0 ± 53.6 min, p = 0.027) was longer and related to a higher estimated blood loss (EBL) ≥ 500 mL (61.9% vs. 40.7%, p = 0.005) in the obese patients than in the non-obese patients. Obesity (odds ratio (OR), 2.204; 95% confidence interval (CI), 1.177−4.129; p = 0.014) and central venous pressure (CVP) ≥ 5 (OR, 2.733; 95% CI, 1.445−5.170; p = 0.002) at the start of the surgery were significant risk factors for EBL ≥ 500 mL. Obese patients with low CVP showed significantly lower EBL than those with high CVP, but a similar EBL to non-obese patients (p = 0.003). In conclusion, fluid restriction before hepatic resection would be important, especially in obese patients, to improve their operative outcomes.
随着需要进行肝切除的肥胖患者数量不断增加，了解他们的手术风险并确定适当的围手术期管理措施很有必要。对2015年3月至2021年7月期间接受肝切除的175例患者进行了评估。根据世界卫生组织对亚洲人的肥胖定义，通过体重指数（BMI）将患者分为两组：肥胖患者（BMI≥25kg/m²，n = 84）和非肥胖患者（BMI＜25kg/m²，n = 91）。肥胖患者的手术时间更长（195.7±62.9分钟 vs. 176.0±53.6分钟，p = 0.027），且估计失血量（EBL）≥500mL的比例更高（61.9% vs. 40.7%，p = 0.005）。肥胖（优势比（OR），2.204；95%置信区间（CI），1.177 - 4.129；p = 0.014）和手术开始时中心静脉压（CVP）≥5（OR，2.733；95%CI，1.445 - 5.170；p = 0.002）是EBL≥500mL的显著危险因素。CVP低的肥胖患者的EBL明显低于CVP高的肥胖患者，但与非肥胖患者的EBL相似（p = 0.003）。总之，肝切除术前限制液体摄入很重要，尤其是对肥胖患者，以改善其手术结局。
