超重和肥胖对腹腔镜腹股沟疝修补术术后并发症的影响

Overweight and obesity in complications of laparoscopic inguinal hernia repair

目的对腹腔镜腹股沟疝修补术治疗的超重和肥胖患者与非肥胖患者术后并发症进行回顾性的比较和分析。方法回顾性分析2008年5月至2014年5月,辽宁省抚顺市中心医院完成的腹腔镜腹股沟疝修补术194例;分为超重和肥胖组患者(A组,BMI≥25.0 cm/kg2),和非超重和肥胖组患者(B组,BMI<25.0 cm/kg2);其中A组患者行TEP术32例,TAPP术23例;B组患者行TEP术77例,TAPP术62例;对围手术期预后指标、并发症和复发率等进行观察和比较。结果入组时A组BMI和腰围与身高比值(WHtR)较B组高(F值分别为82.7和118.5,P<0.001),TEP和TAPP亚组的BMI和WHtR值比较,差异无统计学意义(P>0.05);A组患者的手术时间(F=15.14,P<0.001)、术后下床活动时间(F=11.53,P<0.001)和术后住院时间(F=124.0,P<0.001)显著延长;A组患者的血清肿发生率显著增高(χ2=5.27,P<0.05)。结论 LIHR可安全的应用于超重和肥胖患者的腹股沟疝治疗,但手术难度较大,手术时间较长,术后恢复时间长,血清肿的发生率较高;超重和肥胖对TEP和TAPP患者预后的影响需前瞻性研究进一步证实。

Objective To compare and analyze the complication differences between overweightobesity patients and normal patients after laparoscopic inguinal hernia repair. Methods A total of 194 inguinal hernia patients were enrolled from May 2008 to May 2014. The patients were divided into two groups（ A and B） according to body mass index（ BMI）. In group A（ BMI ≥ 25. 0 kg/m2）,32 cases of TEP and23 cases of TAPP were performed; and in group B（ BMI 25. 0 kg / m2）,77 cases of TEP and 62 cases of TAPP were performed. And prognostic index, complications and recurrence rates were observed and compared. Results BMI and WHtR values were significantly higher in group A than those in group B at baseline（ F = 82. 7 and 118. 5,respectively; P〈0. 001）. There were no significant difference between subgroups of TEP and TAPP（ P〈0. 05）. Operating time（ F = 15. 14,P〈0. 001）,time to ambulation after surgery（ F = 11. 53,P〈0. 001） and length of postoperative stay（ F = 124. 0,P〈0. 001） were significantly longer in group A than those in group B; also,the seroma rate in group A was significantly higher（ χ2= 5. 27,P〈0. 05）. Conclusion It＇ s safe to use laparoscopic inguinal hernia repair in overweight and obesity patients. However,it shows that increasing the difficulty of operation,prolonging operative time and recovery time,and having a higher rate of seroma. The prognostic effects of TEP and TAPP treatment on overweight and obesity patients should be confirmed by further perspective studies.