Is laparoscopic colectomy applicable to patients with body mass index <30?: A case-matched comparative study with open colectomy
Is laparoscopic colectomy applicable to patients with body mass index <30?: A case-matched comparative study with open colectomy
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DOI：
10.1007/s10350-004-0941-0
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发表时间：
2005-05-01
影响因子：
3.9
通讯作者：
Fazio, VW
中科院分区：
文献类型：
--
作者：
Delaney, CP;Pokala, N;Fazio, VW
目得：与开腹结肠切除术相比，腹腔镜结肠切除术后早期术后恢复、术后疼痛减轻、肺功能障碍和住院治疗的益处可能会改善肥胖患者的结局。本病例匹配研究比较了开腹和腹腔镜结肠切除术后的结局。方法：从前瞻性数据库中确定了94例体重指数> 30的腹腔镜结肠切除术患者（1999年1月至2003年6月），并在年龄、性别、体重指数、美国麻醉医师协会分类、手术程序、适应症和手术日期方面与开放性结肠切除术病例相匹配。比较手术时间、住院时间、转换、术中和术后并发症、再手术、30天再入院率和费用。数据表示为平均值标准差，并使用适当的统计检验。研究结果：两组在年龄（P 0.06）、性别（P = 1）、美国麻醉医师协会分级（P = 0.2）、体重指数（P = 0.4）、手术适应症（P = 1）和手术（P = 1）方面匹配。通过使用意向治疗类型分析，中位手术时间没有差异（100 vs. 110（平均，123 vs. 112）分钟; P = 0.1），并发症（21%对24%; P = 0.74），再入院（17% vs. 10.6%; P = 0.3），再次手术率（6.4%对4.3%; P = 0.75），或直接成本腹腔镜结肠切除术与开腹结肠切除术之间的差异（中位数，3，368美元对3，552美元;平均值，4，003美元对4，037美元; P = 0.14）;然而，腹腔镜结肠切除术后的中位住院时间（3 vs. 5.5（平均值，3.8 vs. 5.8）天; P = 0.0001）显著缩短。28例患者因粘连（n = 11）、出血（n = 3）、肥胖妨碍视力或夹层（n = 9）、大输尿管或肿瘤（n = 4）和输尿管损伤（n = 1）而需要转换。转换的平均手术时间为142分钟，住院时间为6.4天。与腹腔镜完成的病例相比，（5 vs. 2（平均值，6.4 vs. 2.8）天; P = 0.0001）和中位手术时间（150 vs. 95（平均值，142 vs. 115）分钟; P = 0.02），但在并发症方面无差异（P = 0.8）、再入院率（P = 1）或再次手术率（P = 0.7）。与开放性结肠切除术相比，转换组的手术时间（P = 0.02）显著更长，但在住院时间（P = 0.18）、并发症（P = 1）、再入院（P = 0.35）或再手术（P = 1）率方面无显著差异。结论：腹腔镜结肠切除术可以安全地用于肥胖患者，术后恢复时间短于开腹结肠切除术。虽然肥胖与高转换率相关，但这些转换病例的结局与匹配的开放病例相当。
PURPOSE: The benefits of early postoperative recovery, reduced postoperative pain, pulmonary dysfunction, and hospitalization after laparoscopic colectomy May improve Outcome over open colectomy in obese patients. This case-matched study compares outcomes after open and laparoscopic colectomy. METHODS: A total of 94 laparoscopic colectomy patients with a body mass index > 30 (Jan 1999-June 2003) were identified from a prospective database and matched to open colectomy cases for age, gender, body mass index, American Society of Anesthesiologists class, procedure, indication, and date of surgery. Operating time, length of stay, conversion, intraoperative and postoperative complications, reoperation, 30-day readmission rate, and costs were compared. Data are presented as means standard deviations, and appropriate statistical tests were used. RESULTS: The two groups were matched for age (P 0.06), gender (P = 1), American Society of Anesthesiologists class (P = 0.2), body mass index (P = 0.4), indication for surgery (P = 1), and procedure (P = 1). By using intention-to-treat-type analysis, there was no difference in median operating time (100 vs. 110 (mean, 123 vs. 112) minutes; P = 0.1), complications (21 vs. 24 percent; P = 0.74), readmission (17 vs. 10.6 percent; P = 0.3), reoperation rates (6.4 vs. 4.3 percent; P = 0.75), or direct costs (median, $3,368 vs. $3,552; mean, $4,003 vs. $4,037; P = 0.14) between laparoscopic colectomy or open colectomy; however, the median length of stay (3 vs. 5.5 (mean, 3.8 vs. 5.8) days; P = 0.0001) was significantly shorter after laparoscopic colectomy. Twenty-eight patients required conversion for adhesions (n = 11), bleeding (n = 3), obesity-hindering vision or dissection (n = 9), large phlegmon or tumor (n = 4), and ureteric injury (n = I). The mean operating time for conversions was 142 minutes and length of stay was 6.4 days. Compared with laparoscopically completed cases, the median length of stay (5 vs. 2 (mean, 6.4 vs. 2.8) days; P = 0.0001) and median operating times (150 vs. 95 (mean, 142 vs. 115) Minutes; P = 0.02) were significantly higher in the converted group, but there was no difference in the complication (P = 0.8), readmission (P = 1), or reoperation (P = 0.7) rates. Compared with open colectomy, the operating time (P = 0.02) was significantly higher in the converted group but there were no significant differences in the length of stay (P = 0.18), complication (P = 1), readmission (P = 0.35), or reoperative (P = 1) rates. CONCLUSIONS: Laparoscopic colectomy can be performed safely in obese patients, with shorter postoperative recovery than that with open colectomy. Although obesity is associated with a high conversion rate, outcome in these converted cases is comparable to the matched open cases.