肥胖妇女腹腔镜全子宫切除术并发症比较与风险评估

Comparison of Complications and Risk Assessment in Obese Women Undergoing Laparoscopic Complete Hysterectomy

目的评估肥胖妇女行腹腔镜全子宫切除术围手术期的安全性。方法回顾分析我院妇产科2011年1月—2014年12月行腹腔镜子宫全切除术506例患者的临床资料,根据患者的体重指数(BMI)将其分为肥胖组244例和正常体重组262例,比较2组的手术的成功率和并发症发生率。结果肥胖组手术时间、术中出血量均高于正常体重组(P<0.01)。肥胖组中转开腹手术率高于正常体重组(P<0.01)。BMI、手术时间、手术时间>120min、出血量>500ml是肥胖患者腹腔镜子宫全切除术中转开腹的危险因素(P<0.01)。2组并发症发生率、二次入院率和二次手术率比较差异无统计学意义(P>0.05)。结论肥胖患者腹腔镜子宫全切除术使手术时间延长和出血量增加,当BMI≥30kg/m2时中转开腹风险明显升高,术前手术方式选择应慎重。术前认真评估和术中规范操作可减少术中及术后并发症。

Objective To evaluate of perioperative safety of obese women undergoing laparoscopic complete hysterectomy.Methods Clinical data of 506 patients undergoing laparoscopic complete hysterectomy between January 2011 and December 2014 in obstetrics and gynecology department was retrospectively analyzed,and the patients were divided into obese group(n=244)and control group(n=262)according to body mass index(BMI).Successful rate and incidence rate of complication were compared in two groups.Results Compared with those in control group,in obese group,values of operative time and intraoperative volume of blood loss were significantly higher(P<0.01),and transferring open operation rate was significantly higher(P<0.01).BMI,operation time more than 120 min and bleeding volume more than 500 ml were risk factors of transferring open operation in obese women undergoing laparoscopic complete hysterectomy(P<0.01).There was no significant differences in incidence rate of complications,secondary admission rate and secondary operation rate between two groups(P>0.05).Conclusion Laparoscopic complete hysterectomy in obese women can prolong operative time and increase bleeding volume.When BMI is more than 30 kg/m 2,transferring open operation risk is significantly increased,and therefore preoperative choice of surgical Methods should be prudent.Carefully preoperative evaluation and standardized intraoperative operation will decrease incidence rate of intraoperative and postoperative complications.