肥胖对手助腹腔镜脾切除联合贲门周围血管离断术的影响

Impact of obesity on hand-assisted laparoscopic splenectomy combined with esophagogastric devascu- larization

目的研究肥胖对手助腹腔镜脾切除联合贲门周围血管离断术患者围手术期的影响。方法回顾性分析解放军302医院普通外科中心2013年1月-2015年11月行手助腹腔镜脾切除联合贲门周围血管离断术患者的临床资料。按照体质量指数（BMI）将患者分为两组：A组（肥胖组）BMII〉28kg／m2和B组（非肥胖组）BMI〈28kg/m2，并将A组分为两个亚组：A1组（巨脾组，脾脏长径〉20em）和A2组（非巨脾组，脾脏长径≤20cm）。统计患者基本数据（年龄、性别、BMI、术前诊断）、手术相关数据（手术时间、出血量、中转开腹率、住院天数）以及术后相关数据（并发症发生率、病死率、随访时间），做组间对比分析。结果本中心共实施160例腹腔镜脾切断流手术，其中A组54例，B组106例。A组患者手术时间较B组长（291min比261min），差异有统计学意义（P〈0．05）。两组患者中转开腹率、出血量、平均住院天数、术后并发症率、病死率、随访时间等差异无统计学意义（P〉0．05）。A1组较A2组手术时间更长，差异有统计学意义（336min比270min；P〈0．01）。A1组比A2组的术中出血量、中转开腹率、总体术后并发症率均较高，但差异无统计学意义（P〉0．05）。结论手助腹腔镜脾切除联合贲门周围血管离断术用于治疗肥胖患者有效、安全、可行，但对于巨脾肥胖患者，手术应谨慎。

Objective To study the impact of obesity on the perioperative outcomes of hand-assisted laparoscopic splenectomy combined with esophagogastric devascularization （LSED）. Methods The clinical data of patients who underwent hand-assisted laparoscopic splenectomy combined with esophagogastric devas- cularization between Jan. 2013 and Nov. 2015 were retrospectively analyzed. The patients were classified as obese group A （BMI≥28 kg,/m2） or non-obese group B （BMI 〈 28 kg/m2）. Group A was further divided into two subgroups： group A1 massive splenomegaly （diameter 〉 20 cm） and A2 splenomegaly （diameter ≤20 cm）. The conversion rates, operative complications, mortality, length of stay, operative time, and blood loss were analyzed and compared. Results One hundred and sixty patients who underwent hand-as- sisted LSED were included into this study. 54 patients were in group A and 106 in group B. A significantly longer operative time was found in group A （291 rain vs. 261 min, P 〈0.05）. The conversion rates, blood loss, length of hospital stay, overall morbidity rates, and mortality rates were similar in the two groups （ P 〉 0.05 ）. The mean operative time was significantly longer in group A1 （336 rain vs. 270 min; P 〈 0.01 ） although blood loss, conversion rates, and overall morbidity rates were higher in group A1. However, there were no significant differences （ P 〉 0.05 ）. Conclusions Hand-assisted laparoscopic splenectomy com- bined with esophagogastric devascularization for obese patients was safe and feasible. However, for patients with massive splenomegaly, LSED should be performed with caution.