Pitkin R M
Surg Gynecol Obstet. 1976 Apr;142(4):532-36.
During a 25 year period in a university hospital gynecology service, 300 obese women, weighing 200 pounds or more, underwent abdominal total hysterectomy. In comparison with nonobese controls, the overweight patients were more likely to have carcinoma of the endometrium, hypertension and diabetes mellitus. Postoperatively, the most striking difference between the obese and nonobese groups was in the incidence of wound complications, with no significant difference in the occurrence of other disorders. The incidence of wound complications was 29 per cent with obesity, seven times that in patients of normal weight, and all types of wound disorders, except evisceration, occurred more frequently in obese patients. Among identifiable factors potentially responsible for wound infection were an increased incidence of diabetes, longer operating time and greater blood loss in overweight patients. The increased incidence of wound infection was responsible for greater febrile morbidity and the more frequent need for prolonged hospitalization. The mortality rate was 1 per cent in the obese group and zero per cent in the control group, a statistically insignificant difference. Since abdominal hysterectomy in obese women is associated with increased risk of morbidity, although not necessarily of mortality, obesity per se should rarely, if ever, contraindicate necessary surgical therapy. In situations in which surgical treatment is more elective, its complications should be borne in mind.
在一所大学医院的妇科服务部门的25年期间，300名体重达到或超过200磅的肥胖女性接受了腹部全子宫切除术。与非肥胖对照组相比，超重患者更易患子宫内膜癌、高血压和糖尿病。术后，肥胖组和非肥胖组之间最显著的差异在于伤口并发症的发生率，而其他疾病的发生率无显著差异。肥胖患者伤口并发症的发生率为29%，是正常体重患者的7倍，除了脏器脱出外，所有类型的伤口疾病在肥胖患者中发生得更频繁。在可能导致伤口感染的可识别因素中，超重患者糖尿病发病率增加、手术时间延长和失血量增加。伤口感染发生率的增加导致了更高的发热发病率以及更频繁地需要延长住院时间。肥胖组的死亡率为1%，对照组为0%，差异无统计学意义。由于肥胖女性的腹部子宫切除术与发病率增加相关，尽管不一定与死亡率相关，肥胖本身很少（如果有的话）应成为必要手术治疗的禁忌证。在手术治疗更具选择性的情况下，应考虑其并发症。
