腹腔镜肝切除术与开腹肝切除术对肥胖患者体型校正出血的影响。
Positive impact of laparoscopic hepatectomy versus open hepatectomy on body size-corrected bleeding in obese patients.
机构信息
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan.
Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
出版信息
Surg Today. 2024 Dec;54(12):1461-1471. doi: 10.1007/s00595-024-02865-3. Epub 2024 Jun 14.
PURPOSE
Laparoscopic hepatectomy (LH) is reported to cause less bleeding than open hepatectomy (OH) in obese patients; however, there are no reports addressing this issue in terms of body size-corrected bleeding.
METHODS
The subjects of this study were 31 obese and 149 non-obese patients who underwent LH and 32 obese and 245 non-obese patients who underwent OH. Bleeding corrected for body surface area (C-BL) was compared between the obese and non-obese patients who underwent each procedure. A multivariate analysis for increased C-BL was performed using the median C-BL for each procedure.
RESULTS
The median C-BL tended to be higher in the obese patients than in the non-obese patients who underwent LH, but there was no significant difference (72 vs. 42 mL/m, P = 0.050). However, it was significantly higher in the obese patients than in the non-obese patients who underwent OH (542 vs. 333 mL/m, P = 0.002). In a multivariate analysis, for OH, sectionectomy or more (OR 3.20, P < 0.001) and a high BMI (OR 2.76, P = 0.018) were found to be independent risk factors, whereas for LH, a high BMI was not (OR 1.58, P = 0.301).
CONCLUSIONS
Obesity was identified as a risk factor for increased bleeding with body size correction for OH, but the risk was reduced for LH.
目的
腹腔镜肝切除术（LH）被报道在肥胖患者中比开腹肝切除术（OH）引起的出血更少；然而，在针对身体大小校正出血方面，尚无相关报道。
方法
本研究的对象为 31 例肥胖和 149 例非肥胖行 LH 患者，以及 32 例肥胖和 245 例非肥胖行 OH 患者。比较了两种手术中肥胖和非肥胖患者的校正体表面积出血（C-BL）。使用每种手术的中位数 C-BL 对增加 C-BL 进行多变量分析。
结果
与非肥胖行 LH 患者相比，肥胖患者的中位 C-BL 趋于更高，但无显著差异（72 与 42 mL/m，P=0.050）。然而，与非肥胖行 OH 患者相比，肥胖患者的中位 C-BL 显著更高（542 与 333 mL/m，P=0.002）。多变量分析显示，OH 中，节段切除术或更广泛的手术（OR 3.20，P<0.001）和高 BMI（OR 2.76，P=0.018）是独立的危险因素，而 LH 中，高 BMI 不是（OR 1.58，P=0.301）。
结论
肥胖被确定为 OH 校正身体大小后出血增加的危险因素，但 LH 风险降低。
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