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肥胖对腹腔镜肝切除术后短期结局的影响:单机构经验

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience.

作者信息

Španring Tajda, Turk Špela, Plahuta Irena, Magdalenić Tomislav, Laufer Kevin, Brumec Aleks, Potrč Stojan, Ivanecz Arpad

机构信息

Medical Faculty, University of Maribor, Maribor, Slovenia.

UMC Maribor, Ljubljanska 5, Maribor, Slovenia.

出版信息

Wideochir Inne Tech Maloinwazyjne. 2024 Mar;19(1):83-90. doi: 10.5114/wiitm.2023.134104. Epub 2023 Dec 29.

Abstract

INTRODUCTION

Obesity is a major public health problem and a well-known cause of multiple comorbidities. With the increasing application of minimally invasive surgery for benign and malignant liver lesions, the results of laparoscopic liver resection (LLR) in obese patients are of great interest.

AIM

To evaluate the short-term operative outcomes after LLR in obese patients and compare them to patients with normal weight and overweight.

MATERIAL AND METHODS

All 235 consecutive patients undergoing LLR from 2008 to 2023 were retrospectively analysed. Patients were categorized into 3 groups based on their body mass index (BMI): normal weight (18.5-24.9 kg/m), overweight (25-29.9 kg/m), and obese (≥ 30 kg/m). The groups were then compared regarding preoperative data and intra- and postoperative outcomes.

RESULTS

Despite higher ASA score and associated comorbidities in the obese group, there were no significant differences in intraoperative complication (blood loss, damage to surrounding structures, conversion rate) between BMI groups (20.8% vs. 16.8% vs. 22.7%, p = 0.619). There were no significant differences in overall morbidity (34.7% vs. 27.7% vs. 29.5%, p = 0.582), as well as major morbidity (15.9% vs. 11.8% vs. 11.4%, p = 0.784) or mortality rates (1.4% vs. 1.7% vs. 0.0%, p = 1.000). Univariate logistic regression did not show BMI or obesity as a predictive variable for intraoperative complication.

CONCLUSIONS

Obesity is not a significant, strong risk factor for worse short-term outcomes, and LLR may be considered also in patients with overweight and obesity.

摘要

引言

肥胖是一个主要的公共卫生问题,也是多种合并症的一个众所周知的病因。随着微创手术在良性和恶性肝脏病变中的应用日益增加,肥胖患者的腹腔镜肝切除术(LLR)结果备受关注。

目的

评估肥胖患者LLR术后的短期手术结果,并将其与体重正常和超重的患者进行比较。

材料与方法

回顾性分析了2008年至2023年连续接受LLR的所有235例患者。根据体重指数(BMI)将患者分为3组:正常体重(18.5 - 24.9 kg/m)、超重(25 - 29.9 kg/m)和肥胖(≥30 kg/m)。然后比较各组的术前数据以及术中和术后结果。

结果

尽管肥胖组的美国麻醉医师协会(ASA)评分较高且存在相关合并症,但BMI组之间在术中并发症(失血、周围结构损伤、中转率)方面无显著差异(20.8%对16.8%对22.7%,p = 0.619)。在总体发病率(34.7%对27.7%对29.5%,p = 0.582)、严重发病率(15.9%对11.8%对11.4%,p = 0.784)或死亡率(1.4%对1.7%对0.0%,p = 1.000)方面也无显著差异。单因素逻辑回归未显示BMI或肥胖是术中并发症的预测变量。

结论

肥胖不是导致短期结果较差的显著强风险因素,超重和肥胖患者也可考虑行LLR。

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