高龄肥胖女性腹腔镜手术和开腹手术疗效比较

Comparison of gynecological laparoscopic surgery with laparotomy for the elderly obese women

目的探讨高龄肥胖患者施行腹腔镜妇科手术的有效性与安全性。方法收集2009年1月至2017年6月在上海交通大学医学院附属瑞金医院妇科手术治疗的高龄(≥70岁)肥胖(BMI>25.0)患者230例,其中行腹腔镜手术122例,开腹手术108例;记录患者美国麻醉师协会生理状况分级标准(ASA)分级、术前合并症、BMI、手术方式、术后诊断及并发症情况,并对手术结果进行统计分析。结果两组患者在年龄、BMI、ASA分级等方面差异无统计学意义,手术以全子宫切除术为多。合并心脏病和中重度肺通气功能障碍的患者多施行开腹手术。腹腔镜在全子宫切除中比开腹手术时间短[(57.26±7.68)min vs.(87.10±10.70)min,P<0.05]、出血量少[(55.27±26.67)mL vs.(105.34±73.03)mL,P<0.05]、排气时间短[(1.34±0.48)d vs.(2.29±0.75)d,P<0.05]、住院时间短[(10.29±3.75)d vs.(14.18±5.44)d,P<0.05]。在恶性肿瘤根治术中腹腔镜在手术时间[(167.69±19.64)min vs.(224.21±33.88)min,P<0.05]和出血量[(193.07±117.50)mL vs.(351.58±261.71)mL,P<0.05]的比较中比开腹手术有优势。尤其Ⅱ度肥胖比Ⅰ度肥胖者出血少的优势更明显。腹腔镜手术术后各类并发症少。良性卵巢巨大囊肿适合腹腔镜手术。结论腹腔镜手术能安全有效地治疗高龄肥胖女性的妇科良恶性疾病。

Objective To evaluate the efficacy and safety of gynecological laparoscopic surgery in elderly obese women.Methods We retrospectively analyzed 230 cases of elderly obese（Body Mass Index,BMI25.0）patients over 70 years old from January 2009 to June 2017 in Ruijin Hospital,School of Medicine,Shanghai Jiao Tong University.Among them 122 cases received laparoscopic surgeries,whereas 108 cases underwent laparotomies. The ASA classifications,preoperative complications,BMI index,surgical methods,postoperative diagnosis results and complications were recorded and analyzed statistically.Results There were no significant differences in age,ASA classifications or BMI index between the two groups. More patients with cardiac disease or moderate to severe pulmonary ventilation dysfunction underwent laparotomy. Laparoscopic hysterectomy was superior to laparotomy surgery in surgical time[（57.26±7.68）min vs.（87.10±10.70）min,P0.05],bleeding[（55.27±26.67）m L vs.（105.34±73.03）mL,P0.05],anal evacuation[（1.34±0.48）d vs.（2.29±0.75）d,P0.05]and length of hospital stay[（10.29±3.75）d vs.（14.18±5.44）d,P0.05].Laparoscopic radical surgery also took less surgical time[（167.69±19.64）min vs.（224.21±33.88）min,P0.05]and had less bleeding[（193.07±117.50）mL vs.（351.58±261.71）mL,P0.05]than laparotomy surgery.Laparoscopic surgery had a greater advantage of reducing peri-operative bleeding in the Ⅱ obese women.The postoperative complications of laparoscopic surgery were fewer than those of laparotomy and vaginal surgery.Laparoscopic surgery was suitable for large ovarian cyst.Conclusion Laparoscopy is a safe and effective treatment for elderly obese patients with benign and malignant gynecologic diseases.