体质指数对后腹腔镜下肾部分切除术的影响

Impact of body mass index on retroperitoneal laparoscopic partial nephrectomy

目的：探讨体质指数（body mass index，BMI）对后腹腔镜下肾部分切除术的手术操作及术后恢复情况的影响。方法：回顾性分析2012年1月～2014年7月于我院行后腹腔镜下肾部分切除术患者的临床资料，按BMl分为两组：非肥胖组（BM1〈25kg／m2）43例，超重组（BMI≥25kg／m2）57例，分别比较两组手术时间、术中出血量、术中肾脏缺血时间、手术前后血红蛋白差值、术后住院天数、留置引流管时间、引流量，并发症发生等情况。结果1100例行后腹腔镜下肾部分切除术患者中，超重组肿瘤直径1．0～6cm，非肥胖组肿瘤直径0．5～4cm，两组患者术后引流量、引流管留置天数、术后住院天数及术后并发症发生率差异无统计学意义（P〉0．05）；两组手术时间分别为（151．7±48．8）min和（131．3±32．2）min，肾脏热缺血时间分别为（23．5±4．8）min和（21．3±4．7）rain，术中出血量分别为（87．9±134．1）ml和（51．6±55．3）ml，手术前后血红蛋白差值分别为（17．8±16．5）g／L和（12．8±9．6）g／L，超重组指标均高于非肥胖组，差异均有统计学意义（P〈0．05）。结论：对于行后腹腔镜下肾部分切除术的患者，BM1的增加将增加手术时间、术中出血量及术中肾脏热缺血时间，而对于术后的恢复及并发症的发生情况并无明显影响。

Objective： To investigate the impact of body mass index （BMI） on operation and postoperative re- covery of patients undergoing retroperitoneal laparoscopic partial nephrectomy. Method： A retrospective analysis of 100 patients with renal masses undergoing retroperitoneal laparoscopic partial nephrectomy from January 2012 to July 2014 in our hospital was performed. The patients were divided into two groups according to BMI： non- obese group （BMl〈25 kg/m2） and overweight group （BMI≥25 kg/m2）. The operation time, blood loss during operation, warm ischemia time, variation in pre- and postoperative hemoglobin values, postoperative hospital stay, duration and volume of indwelling drainage, and postoperative complications were compared between the two groups. Result.. There were 57 patients with BMI≥25 kg/m2 and 43 cases with normal BMI. The tumor diameter were 1.0-6.0 cm in overweight group, and 0.5-4.0 cm in non-obese group respectively. There was no significant difference between two groups with respect to the duration and volume of drainage, postoperative hospital stay, and the incidence of complications （P〉0.05）. Compared with non-obese group, overweight group indicated lon- ger operation time l-non-obese （131.3±32.2） rain vs overweight （151.7±48.8） mini, and warm ischemia time [non-obese （21.3 ± 4.7） rain vs overweight （23. 5 ± 4.8） mini, more blood loss during operation[non-obese （51.6±55.3） ml vs overweight （87.9±134.1） ml], and more hemoglobin decrease [non-obese （12.8±9.6） g/L vs overweight （17.8±16.5） g/L] （P〈0.05）. Conclusion： For patients undergoing retroperitoneal laparoscopic partial nephrectomy, a larger BMI may lengthen the operation time and warm ischemia time, increase blood loss during operation whereas there is no remarkable influence on postoperative recovery and the occurrence of compli- cations.