高血压患者体重指数与脂肪肝相关性探讨

目的　探讨高血压患者体重指数与脂肪肝、血脂及血压之间的关系。方法　对 13 5例高血压患者按体重指数(BMI)分为 3组 :正常体重组 (BMI=2 0～ 2 3 ) ,超重组 (BMI=2 4～ 2 7) ,肥胖组 (BMI≥ 2 8) ,所有患者均测血脂、血压 ,并行腹部 B超检查。结果　肥胖组较正常组总胆固醇 (TC)、三酰甘油 (TG)、低密度脂蛋白 (L DL )有明显差异(P<0 .0 5 ) ;肥胖组与超重组比较 ,仅 TC有差异 (P<0 .0 5 )。 BMI与脂肪肝的发生率呈正相关 (rs=0 .911,P<0 .0 1) ,且肥胖组中中、重度脂肪肝的发生率较正常组明显增多 (P<0 .0 1)。收缩压 (SBP)及舒张压 (DBP)均随着BMI的增加而明显增高 :肥胖组高于超重组 ,超重组高于正常组 ,差异有显著性 (P<0 .0 0 1及 P<0 .0 5 )。结论　合并超重的高血压患者应积极减重 ,并控制在正常范围 ,对降低血压、预防冠心病及脂肪肝均有重要意义     

Association of dysfunctional uterine bleeding with high body mass index and obesity as a main predisposing factor

BackgroundDysfunctional uterine bleeding (DUB) defined as abnormal uterine bleeding in the absence of underlying structural abnormalities. Recently, obesity has been suggested as a main underling risk factor for DUB; however, evidences on the role of this predisposing factor are not adequate. The current study aimed to assess status of obesity in women who suffered from DUB.MethodsIn an observational case series study conducted at a referral endocrinology clinic in Shahrood city, Samnan, 20 consecutive women with the final diagnosis of DUB referred from 2009 to 2011 were evaluated. Obesity was assessed using calculation of body mass index (BMI) and waist circumference.ResultsThe mean waist circumference was estimated 102.95 ± 9.77 cm in the range of 90–119 cm. With respect to BMI measurement, the mean of BMI was 32.63 ± 3.34 kg/m² ranged between 26.92 and 39.06 that two-third of studied women suffered from overweight status and other one-third cases were obese.ConclusionThere is a strong association between obesity and DUB and therefore weight reduction should be considered as a conservative treatment besides of other medical or surgical treatment approaches.     

Associations between body mass index and mortality in acute-on-chronic liver failure patients

Introduction and objectivesThe association between the level of body mass index (BMI) and the mortality of patients with critical liver disease remains unclear. This study aimed to examine the association between BMI and hospital mortality of patients with acute-on-chronic liver failure (ACLF).MethodsClinical data from 146 ACLF patients were collected and analyzed. BMI was categorized into three groups: lower BMI (<18.5 kg/m²), normal BMI (18.5–24.9 kg/m²), and overweight (25.0–32.0 kg/m²). BMI and laboratory parameters were measured one day before, or on the day of the start of the treatment. Values of BMI and laboratory parameters were compared between survivors and non-survivors, and then hospital mortality rates were compared among patients with different BMI levels.ResultsThe prognosis of ACLF patients was significantly correlated with international normalized ratio (INR), albumin and BMI. The ACLF patients with low albumin level and high INR values tend to have a high mortality rate. Also, survival time was significantly shorter in the ACLF patients with lower BMI, while patients with normal and overweight values had longer survival time.ConclusionsA graded association between BMI and hospital mortality with a strong significant trend was found in ACLF patients in China.     

4784例老年男性血脂分布的特点及与体质指数关系的研究

目的 了解老年男性血脂分布的规律及与体质指数(BMI)的关系,从血脂紊乱的角度探讨老年男性的体质量控制问题.方法 对4784例老年男性体检者进行调查并测定血脂水平,按年龄分为60～69岁组、70～79岁组和80～96岁组,按BMI水平分为低体质量组(BMI<18.5 kg/m2),正常体质量组(BMI:18.5～23.9 kg/m2),超质量组(BMI:24.0～27.9 kg/m2),肥胖组(BMI≥28.0 kg/m2).结果 4784例老年男性总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)分别为(5.1±0.9)mmol/L、(3.0±0.8)mmol/L、(1.5±1.0)rmmol/L、(1.3±0.3)mmol/L,血脂异常的检出率为44.8%(2141例),其中TC、TG、HDL-C异常的检出率分别为10.4%(497例)、9.3%(445例)、29.8%(1425例)和19.4%(928例).不同年龄组随增龄TG水平降低,HDL-C水平升高(均P<0.01),80～96岁组的TC和LDL-C水平有降低趋势(P<0.05).老年男性超体质量占46.8%(2239例),肥胖占15.5%(740例).随BMI水平的升高,TG水平亦升高,而HDL-C则随BMI升高降低,不同体质量组TC和LDL-C比较差异无统计学意义.80～96岁组亦以高TG和低HDL-C为主要类型的血脂异常,其血脂分布特点与70～79岁组相似.80～96岁组肥胖和超体质量的检出率最低,分别为44.6%(228例)和11.9%(61例).结论 老年男性血脂异常以高TG和低HDL-C为主,TC升高的检出率高于2002年全国普查的结果;超体质量、肥胖的检出率接近发达国家水平;老年男性随增龄TC和LDL-C水平下降,而HDL-C水平有上升趋势.     

A novel difficulty scoring system for laparoscopic liver resection

Early on, laparoscopic liver resection (LLR) was limited to partial resection, but major LLR is no longer rare. A difficulty scoring system is required to guide surgeons in advancing from simple to highly technical laparoscopic resections. Subjects were 90 patients who had undergone pure LLR at three medical institutions (30 patients/institution) from January 2011 to April 2014. Surgical difficulty was assessed by the operator using an index of 1–10 with the following divisions: 1–3 low difficulty, 4–6 intermediate difficulty, and 7–10 high difficulty. Weighted kappa statistic was used to calculate the concordance between the operators' and reviewers' (expert surgeon) difficulty index. Inter‐rater agreement (weighted kappa statistic) between the operators' and reviewers' assessments was 0.89 with the three‐level difficulty index and 0.80 with the 10‐level difficulty index. A 10‐level difficulty index by linear modeling based on clinical information revealed a weighted kappa statistic of 0.72 and that scored by the extent of liver resection, tumor location, tumor size, liver function, and tumor proximity to major vessels revealed a weighted kappa statistic of 0.68. We proposed a new scoring system to predict difficulty of various LLRs preoperatively. The calculated score well reflected difficulty.     

体质量指数与结直肠癌相关性的研究现状

结直肠癌(colorectal cancer,CRC)是消化系统常见的严重危害人们健康的杀手,全球每年约有120万新发病例,其中中国约有13万.随着我国社会经济发展和饮食结构的改变,CRC的发病率和死亡率呈逐年上升趋势,且平均发病年龄低于西方国家约20岁,居所有恶性肿瘤中的第2位,在中国发达地区已经接近西方发达国家.CRC的发病是多种因素综合作用的结果,近四分之一的CRC患者可以通过良好的生活习惯来避免患病.目前全球有2/3的成年人正在与超重和肥胖做斗争.近期大量研究表明,高体质量指数(body mass index,BMI)与结直肠癌的发病具有一定关系.本文就BMI与CRC相关性的研究现状作一综述.     

Diagnostic performance of body mass index to detect obesity in patients with coronary artery disease.

BACKGROUND: Emerging evidence suggests that a mildly elevated body mass index (BMI), is related to improved survival and fewer cardiovascular events in patients with coronary artery disease (CAD). We hypothesize that these results are related to the poor diagnostic performance of BMI to detect adiposity, especially in the intermediate BMI ranges. METHODS AND RESULTS: A cross-sectional study of 95 patients with CAD referred to phase II cardiac rehabilitation. Body fat (BF)% was estimated by air displacement plethysmography. Height, weight, BMI and waist circumference were measured the same day. We calculated the correlation between BMI and both, BF% and lean mass and assessed the diagnostic performance of BMI to detect obesity defined as a BF% > 25% in men and > 35% in women. Although BMI had a good correlation with BF% (rho = 0.66, P < 0.0001), it also had a good correlation with lean mass (rho = 0.41, P < 0.0001), and BMI failed to discriminate between both (P-value = 0.72). A BMI >or= 30 kg/m2 had a good specificity (95%; 95% CI, 83-100) but a poor sensitivity (43%; 95% CI, 32-54) while a BMI >or= 25 kg/m2 had a good sensitivity (91%; 95% CI, 84-97) but a poor specificity (65%; 95% CI, 42-88) to detect BF%-obesity. CONCLUSIONS: In patients with CAD, BMI does not discriminate between BF% and lean mass, and a BMI < 30 kg/m(2) is a poor index to diagnose obesity. These findings may explain the controversial findings that link mild elevations of BMI to better survival and fewer cardiovascular events in patients with CAD. Body composition techniques to accurately diagnose obesity in patients with CAD might be necessary.     

体重指数在老年代谢综合征人群中诊断价值的初步探讨

目的了解老年人群中体重指数（BMI）与代谢综合征患病及相关代谢异常之间的关系。方法683例65岁以上（平均71．2岁）的老年男性,以中华医学会糖尿病学分会制订的代谢综合征工作定义作为标准,按照BMI进行分层,分析不同BMI人群代谢综合征的患病率及各项代谢指标的异常情况。结果（1）当BMI≥123kg／m^2时,代谢综合征的患病率随BMI的增加显著上升,BMI和代谢异常数量之间呈现一种正相关趋势（r=0．557）;（2）BMI增加与收缩压（SBP）、舒张压（DBP）、血甘油三酯之间正相关（r值分别为0．189、0．198和0．201）,与血高密度脂蛋白胆固醇之间负相关（r=-0．157）;（3）在血压正常人群和在非糖尿病人群,BMI与SBP、DBP、空腹血糖及餐后2h血糖之间显著正相关;（4）冠心病和肾脏损害患者的BMI显著高于无相关疾病人群（P〈0．05）;（5）冠心病、肾脏损害和脑血管病变患者中的代谢综合征患病率显著高于没有这些疾病的人群（P〈0．05）。结论随着BMI的增加,代谢指标异常的数量逐渐增加,代谢综合征的患病率也逐渐升高。BMI的增加与冠心病、肾脏损害和脑血管病变的发病相关。     

人体质量指数及其变化与非酒精性脂肪性肝病发病的关系

目的 探讨健康成人基线体质量及其变化与非酒精性脂肪性肝病(NAFLD)发病的关系.方法 回顾性分析1999年和2001年上海宝山钢铁责任有限公司的普通员工健康体检资料,主要包括个人嗜好、既往病史、人体学指标、动脉血压,空腹血清甘油三酯(TG)、总胆固醇、葡萄糖、ALT以及肝脏实时超声的检查结果.选择研究期间无习惯性饮酒史[每月饮酒小于2次和(或)每周饮用乙醇量小于140 g]以及基线时血清ALT正常(小于40 U/L)和实时超声检查未发现脂肪肝者为研究对象.血清生物化学指标用Bayer 1650全自动生物化学分析仪测定,由同一名资深影像学医师利用同一台1400型Aloka实时超声显像仪(探头频率3.5MHz)作肝脏检查.应用SPSS12.0统计软件进行数据分析,计量资料用均数±标准差表示,采用t检验、方差分析、非参数检验.计数资料用率表示,采用x2检验.结果 有5402例研究对象2年后再次体检时影像学诊断脂肪肝327例(6.05%),每1000人每年发生NAFLD 30例.年龄＜50岁发生脂肪肝者占5.7%(281/4624),≥50岁发生脂肪肝者占9.3%(46/451),x2=9.87,P＜0.01.人体质量指数(BMI)差值在无脂肪肝组为0.50±1.29,脂肪肝组为0.95±1.25,t-6.11,P＜0.01.TG差值在无脂肪肝组为(0.11±1.06)mmol/L,脂肪肝组为(0.35±1.71)mmol/L,t=2.48,P＜0.05.TC差值无脂肪肝组为(0.52±0.63)mmol/L,脂肪肝组为(0.62±0.70)mmol/L,t=2.40,P＜0.05.NAFLD的发病率随基线BMI增加而显著增高,趋势分析显示x2=389.01,P=0.000.体质量正常、超重、肥胖症和重度肥胖症患者NAFLD发病率分别为1.4%、6.4%、16.8%和24.5%.多元回归分析显示基线年龄、BMI和血清TG水平以及随访期间BMI和TG增加幅度与NAFLD的发病密切相关.结论 普通职工NAFLD发病率高,基线时肥胖和代谢紊乱以及随访中体质量和TG增加是发生NAFLD的重要预测因素.     

不同体重指数新型冠状病毒肺炎患者的临床特点及转归

目的:探讨不同体重指数(BMI)新型冠状病毒肺炎(COVID-19)患者的临床特点及转归,为病情评估及预后提供依据。方法:收集2020年1月16日至2020年3月28日在武汉科技大学附属孝感医院确诊的541例COVID-19患者临床资料,根据BMI分为正常体重组、超重组和肥胖组,比较3组患者的临床特点及转归。采用有序 ...     

Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8

Performing laparoscopic liver resection for lesions located in segment 7 and 8 is technically difficult, as the operative field is far from the conventional trocar site, and the liver impedes free motion of the laparoscopic instrument. Inserting the port through the intercostal space (ICS) may facilitate liver resection for these lesions. From January 2012 to July 2013, five patients (four men and one woman) underwent laparoscopic S7 or 8 segmentectomy for liver metastasis and hepatocellular carcinoma (HCC). Ports were inserted at the 7th and 9th ICS, respectively, in addition to conventional abdominal ports. The mean age was 58 ± 10 (45–74) years; operation time, 197 ± 68 (110–300) minutes; blood loss, 161 ± 138 (40–320) ml; and length of hospital stay, 7 ± 3 (4–12) days. Pathologic findings revealed three, one, and one case(s) of colon cancer metastasis, breast cancer metastasis, and HCC, respectively. The mean tumor size and tumor‐free margin were 2.2 ± 1.1 cm and 5.8 ± 1.9 mm, respectively. There were no postoperative complications. Laparoscopic liver resection using intercostal trocars could be a useful method for tumors located in segments 7 and 8 of the liver in selected patients.     

体质量指数与左心房大小的相关性研究

目的:肥胖是心房纤颤(房颤)的一个危险因素,但是这种联系的机制还不清楚。本研究旨在评价在窦性心律个体,其体质量指数(BMI)是否是左心房大小的独立决定因素。方法:连续观察18岁以上来我院行经胸超声心动图检查的非心血管病患者180例,均符合窦性心律、左心室收缩功能正常且无瓣膜病及其它心脏病等,记录其年龄、性别,并测量身高及体质量。应用二维及M型超声心动图技术测量左心房大小、左心室功能及左心室后壁厚度(LVPW)。结果:入选者平均年龄(45.54±13.33)岁,体质量指数(24.75±3.65)kg/m2,其中57.2%为男性,BMI是左心房大小的重要预测因子(P<0.001),独立于左心室舒张末内径和左心室后壁厚度。BMI<25 kg/m2者平均左心房面积是(14.16±2.49)cm2,BMI≥25 kg/m2者平均左心房面积是(15.77±2.88)cm2(P<0.001)。结论:在非心血管病者中,肥胖与左心房增大相关,而且独立于左心室大小和左心室后壁厚度。这可能至少部分地有助于解释肥胖人群房颤发生率的增高。     

Costs of laparoscopic and open liver and pancreatic resection: A systematic review

AIM: To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.METHODS: A systematic review of the literature was performed using the Medline, Embase, PubMed, and Cochrane databases to identify all studies published up to 2013 that compared laparoscopic and open liver [laparoscopic hepatic resection (LLR) vs open liver resection (OLR)] and pancreatic [laparoscopic pancreatic resection (LPR) vs open pancreatic resection] resection. The last search was conducted on October 30, 2013.RESULTS: Four studies reported that LLR was associated with lower ward stay cost than OLR (2972 USD vs 5291 USD). The costs related to equipment (3345 USD vs 2207 USD) and theatre (14538 vs 11406) were reported higher for LLR. The total cost was lower in patients managed by LLR (19269 USD) compared to OLR (23419 USD). Four studies reported that LPR was associated with lower ward stay cost than OLR (6755 vs 9826 USD). The costs related to equipment (2496 USD vs 1630 USD) and theatre (5563 vs 4444) were reported higher for LPR. The total cost was lower in the LPR (8825 USD) compared to OLR (13380 USD).CONCLUSION: This systematic review support the economic advantage of laparoscopic over open approach to liver and pancreatic resection.     

体质量指数对老年卒中患者康复进程影响的相关性研究

目的探讨老年卒中患者的体质量指数（BMI）对康复进程以及其卒中后康复结局的影响。 方法选择从2018年1月至2019年12月因卒中于广东燕岭医院住院的患者共95例,本根据患者的体质量指数（BMI）分为三组,其中18.5 kg/m²≤BMI<25 kg/m²为正常组（n=40）,25 kg/m²≤BMI<30 kg/m²为超重组（n=37）,BMI≥30 kg/m²为肥胖组（n=18）,记录三组患者康复干预前、干预后及3个月后的Barthel指数评分、Ashworth量表评分、Fugl-Meyer上肢运动功能评分和Brunel平衡评分。 结果三组患者干预前的Barthel指数评分、Ashworth量表评分、Fugl-Meyer上肢运动功能评分和Brunel平衡评分对比差异均无统计学意义（P>0.05）。干预后和干预3个月肥胖组的Barthel评分、Fugl-Meyer评分和Brunel平衡评分显著低于超重组和正常组（P<0.05）,而肥胖组的手、前臂和下肢Ashworth评分均显著高于正常组和超重组（P<0.05）。 结论超重及肥胖的BMI降低了卒中患者的康复进程,影响了生活能力、四肢功能及平衡力的康复。     

Effect of body mass index on Argatroban therapy during percutaneous coronary intervention

BACKGROUND: Obesity is common in patients undergoing percutaneous coronary intervention (PCI). Argatroban, a direct thrombin inhibitor, is used during PCI in patients with or at risk of heparin-induced thrombocytopenia (HIT) and also has been evaluated in conjunction with glycoprotein IIb/IIIa inhibition in nonHIT patients. We investigated the effect of body mass index (BMI), and specifically obesity (BMI>30 kg/m2), on argatroban therapy during PCI. METHODS: From previously reported studies of argatroban therapy during PCI in patients with or at risk of HIT (ie, HIT group) or in conjunction with glycoprotein IIb/IIIa inhibition (ie, nonHIT group), we identified patients with sufficient data to determine BMI. After an initial bolus of 350 microg/kg (HIT group) or 300 or 250 microg/kg (nonHIT group), patients received continuous argatroban 25-30 microg/kg/min (adjusted to achieve ACTs of 300-450 s, HIT group) or 15 microg/kg/min (target ACTs of 275-325 s, nonHIT group) during PCI, with additional 150 microg/kg boluses allowed if needed. Regression analyses evaluated relationships between patient BMI and ACT response to initial bolus administration, mean infusion dose (HIT group only), and rate of ACT decline after PCI. Frequencies of additional bolus usage and clinical outcomes were compared between obese and nonobese patients. RESULTS: Our analysis population included 225 patients (85 obese) in total: 73 in the HIT group and 152 in the nonHIT group (300 microg/kg bolus, n=101; 250 microg/kg bolus, n=51), with BMIs of 16.3-50.9 kg/m2. No association was detected between BMI and the first ACT after bolus administration (median ACTs of 361, 298, and 289 s, respectively, following 350, 300, and 250 microg/kg bolus), mean infusion dose (24.2+/-4.9 microg/kg/min overall in HIT group), or time to ACTsor=0.35). Clinical outcomes did not differ (P>or=0.09) between obese and nonobese individuals: 4 (3 obese) patients in the HIT group and 4 (2 obese) in the nonHIT group had ischemic complications; 1 nonobese patient in the HIT group and 2 (1 obese) in the nonHIT group experienced major bleeding. CONCLUSIONS: These findings support the use of actual body weight-adjusted (and ACT-targeted) argatroban therapy during PCI and suggest that dose adjustment for obesity (BMI up to 50.9 kg/m2) is unnecessary.     

Differential associations between body mass index and outcome in different age groups in patients with myocardial infarction

ObjectiveTo investigate the association between age and body mass index (BMI) and mortality in patients with myocardial infarction (MI). Methods We divided 6453 patients into three age groups (<60, 60–75, >75 years) and five BMI categories. Thirty-day and long-term all-cause mortality were assessed.ResultsNo association was found between the BMI category and 30-day mortality in any age group. The association between BMI and long-term multivariable-adjusted mortality risk was age-dependent. Overweight patients had a lower risk than patients with BMI <25 kg/m² in all age groups (HR 0.62; 95%CI 0.45–0.85; p = 0.003, HR 0.78; 95%CI 0.65–0.93; p = 0.005, HR 0.82; 95%CI 0.70–0.95; p = 0.011 for ages <60, 60–75, >75 years, respectively). The lower risk of death as a function of BMI shifted upward with age, and the risk was also lower in patients with obesity grade I (HR 0.81; 95% CI 0.66–0.98; p = 0.035 and HR 0.78; 95% CI 0.63–0.97; p = 0.023 for ages 60–75, >75 years, respectively). Excessive obesity was harmful only in the oldest group. Patients with obesity grade III had more than a 2.5 times higher mortality risk than patients with BMI <25 kg/m² only in this group (HR 2.58; 95%CI 1.27–5.24; p = 0.009). An obesity paradox was found in all age groups.ConclusionOur results suggest that moderate weight gain with age improves long-term survival after MI and that the magnitude of this “protective” weight gain is greater in older compared to younger patients. However, excessive weight gain (obesity grade III) is particularly harmful in the oldest age group. The exact relationship between BMI, age, and mortality remains unclear.     

Effect of body mass index on bone mineral density is age-specific

Background and aimsObesity and osteoporosis are two important and growing public health problems worldwide. Body mass index (BMI) has been found to be inversely related to the risk of osteoporotic fracture. We aimed to assess the association of BMI with thoracic vertebral bone mineral density (BMD) measured from a quantitative computed tomography (QCT).Methods and resultsWe retrospectively evaluated the data from 15,758 consecutive patients (5675 females and 10,083 males) between age 20–90 years, who underwent Coronary Artery Calcium (CAC) scoring. Quantitative data analyses of thoracic trabecular BMD (mg/cm³) was performed with a phantom system or phantomless using validated software. The gender-specific subgroup was divided based on age (<45, 45–55, 55–65, >65 yrs in females; <40,40–60,>60 yrs in Males) and weight by BMI (kg/m²) as < 25 (normal or low weight), >25 - <30 (overweight) and >30 (obesity). Analysis of variance (ANOVA) and Scheffe's post hoc procedure tested the association of body weight/BMI on BMD. A significant positive association between the body weight and BMD existed in obese population in elder groups in both genders (p < 0.05). There was no significant difference in BMD in 40–60 years in men and <55 years in women with normal or low weight compared to overweight or obese cohorts.ConclusionsWe concluded that the effect of weight on BMD is age-specific and the BMD should be monitored routinely with a cardiac CT scan in the senile population.     

A common polymorphism is associated with body mass index in Uyghur population

We aimed at observing the association of a common genetic variant near the INSIG2 gene (rs7655505) with body mass index (BMI) related obesity in a population-based association study in Uyghur population. We observed a significant association of rs7566605 polymorphism with BMI related obesity in Uyghurs with an odds ratio of 1.47 (95% CI 1.11–1.95, P = 0.006) under a dominant model (CC + GC versus GG). The mean BMI of rs7566605 CC + GC was 0.59 kg/m² higher than for GG genotype (P = 0.024), regardless of sex and age.     

腹腔镜与开腹肝切除术治疗肝内胆管细胞癌患者疗效与安全性研究

目的 比较腹腔镜肝切除术(LLR)与开腹肝切除术(OLR)治疗肝内胆管细胞癌(ICC)患者的疗效与安全性。方法 2015年1月～2018年6月我院诊治的ICC患者74例,其中32例接受LLR手术,另42例接受OLR手术。随访3年。结果 两组年龄、性别、腹部手术史、血清CA19-9和CEA水平、神经侵犯、微血管侵犯、肿瘤低分化、肿瘤直径和淋巴结肿大等差异无统计学意义(P>0.05);LLR组术中失血量、手术切口长度、肝门阻断、术后住院日、输血和胃肠道功能恢复时间分别为325(250,475)ml、5(3.5,6.5)cm、9例(28.1%)、7(5,12)d、2例(6.2%)和2(2,4)d,与OLR组【分别为500(375,750)ml、20.5(17.0,25.0)cm、31例(73.8%)、10(7,15)d、7例(16.7%)和4(3,6)d】比,差异具有统计学意义(P<0.05),而两组1 a生存率(81.2%对76.2%)和3 a生存率(46.8%对33.3%)无显著性差异(P>0.05);术后,两组均未发生严重并发症。结论 在当前情况下,采取OLR或LLR...     

Status and perspective of laparoscopic repeat liver resection

Liver resection(LR) is now actively applied to intrahepatic recurrence of liver metastases and hepatocellular carcinoma. Although indications of laparoscopic LR(LLR) have been expanded, there are increased risks of intraoperative complications and conversion in repeat LLR. Controversy still exists for the indication. There are 16 reports of small series to date. These studies generally reported that repeat LLR has better short-term outcomes than open(reduced bleedings, less or similar morbidity and shorter hospital stay) without compromising the long-term outcomes. The fact that complete adhesiolysis can be avoided in repeat LLR is also reported. In the comparison of previous procedures, it is reported that the operation time for repeat LLR was shorter for the patients previously treated with LLR than open. Furthermore, it is speculated that LLR for minor repeat LR of cirrhotic liver can be minimized the deterioration of liver function by LR. However, further experience and evaluation of anatomical resection or resections exposing major vessels as repeat LLR, especially after previous anatomical resection, are needed. There should be a chance to prolong the overall survival of the patients by using LLR as a powerful local therapy which can be applied repeatedly with minimal deterioration of liver function.