体质指数对后腹腔入路机器人肾部分切除术围手术期安全性的影响

Effect of body mass index on the perioperative safety of retroperitoneal approach robot assisted partial nephrectomy

目的:总结BMI对于后腹腔入路机器人肾部分切除术围手术期安全性的影响。方法:回顾性分析2015年1月~2016年12月中国人民解放军总医院泌尿外科行后腹腔入路机器人肾部分切除术267例具有完整影像学资料患者的临床资料,分析患者BMI与相关围手术期数据,包括手术时间、热缺血时间、术中估计失血量、术后切缘情况、术后住院时间、围手术期并发症等因素的相关性。结果:267例患者中,男175例,女92例,年龄18~85岁,平均(51.38±12.4)岁。BMI为16.4~35.16kg/m^2,平均(25.67±3.41)kg/m^2。采用中国肥胖问题工作组(WGOC)针对中国人群特点制定的标准进行BMI分组,各组间年龄、性别、CCI评分、肿瘤直径、R.E.N.A.L比较差异无统计学意义。267例手术均获成功,无一例中转开放手术,各组间的手术时间、热缺血时间、术中估计出血量、术后住院时间、围手术期并发症比较均差异无统计学意义。结论:后腹腔入路机器人肾部分切除术在超重和肥胖人群中安全可行。

Objective:To study the effect of body mass index(BMI)on the perioperative safety of retroperitoneal approach robot assisted partial nephrectomy(RPRPN).Methods:Clinical data of 267 patients receiving RPRPN in Chines PLA General Hospital from January 2015 to December 2016 were retrospectively analyzed,including the operation time,warm ischemia time,intraoperative estimated blood loss,positive margin,postoperative hospital stay,perioperative complications.The correlation of BMI and perioperative factors was analyzed.Results:There were 175 males and 92 females,aged 18 to 85 years old,with an average age of(51.38±12.4)years.267 cases were divided into 3 groups according to the Chinese population BMI standard of Working Group on Obesity in China(WGOC),including BMI<24 kg/m^2(normal),24.0-27.9 kg/m^2(overweight),28 kg/m^2(obesity).The age,gender,CCI score,tumor diameter and R.E.N.A.L score among the groups showed no statistically significant difference.RPRPN was performed successfully on all the 267 cases without conversion to open surgery.There were also no statistically significant differences in the operation time,warm ischemia time,intraoperative estimated blood loss,positive margin,postoperative hospital stay and perioperative complications among three groups.Conclusions:The RPRPN is effective and safe in overweight and obese patients.