目的：探讨体质量指数（Body mass index，BMI）对机器人辅助腹腔镜全子宫切除术的影响。方法：收集中国医科大学附属第一医院妇科行机器人辅助腹腔镜全子宫切除术的 131 例患者的临床资料，根据体质量指数的不同，将患者分为正常体重组（BMI<24kg/m2 ）、超重组（BMI 为 24~28kg/m2 ）和肥胖组（BMI ≥ 28kg/m2 ）， 比较三组患者年龄、术前有内科合并症（高血压、冠心病或糖尿病）患者的占比、手术时间、中转开腹率，以及术后血红蛋白下降程度、排气时间、术后住院日等。结果：超重组和肥胖组术前有内科合并症（高血压、冠心病或糖尿病）患者的比例超过正常体重组。而在年龄、手术时间、术后血红蛋白下降程度、排气时间、术后住院日方面，体重正常组与超重组及肥胖组比较，差异无统计学意义（P>0.05），所有患者无 1 例中转开腹。结论：机器人辅助腹腔镜全子宫切除术对于超重及肥胖的患者是安全、可行的，在患者基础条件不佳的情况下，可以获得与正常体重患者相似的术中及术后结局，是一种可以选择的手术方式。

Objective: To study the effect of body mass index (BMI) on robot-assisted laparoscopic hysterectomy (RALH). Methods: The clinical data of 131 patients who underwent RALH in the department of gynecology of the First Hospital of China Medical University were collected and divided into normal weight group (BMI<24kg/m2 ), overweight group (BMI ≥ 24kg/m2 and <28kg/m2) and obese group (BMI ≥ 28kg/m2) according to their body mass indexes. Age, proportion of patients with medical comorbidities (hypertension, coronary heart disease or diabetes) before surgery, operation time, conversion rate to laparotomy, decreasing of hemoglobin after surgery, time of exhaust, length of hospital stays after surgery of the three groups were compared and analyzed. Results: The proportion of patients with medical comorbidities in the overweight group and obese group was higher than that in the normal weight group. In terms of age, operation time, postoperative hemoglobin decline, time of exhaust, length of hospital stay after surgery, no significant differences were found among the three groups (P>0.05). No conversion to laparotomy happened. Conclusion: RALH is safe and feasible for overweight and obese patients, which can achieve similar intraoperative and postoperative outcomes in patients under poor basic conditions to normal weight patients. RALH is an alternative surgical procedure for overweight and obese patients.

收稿日期：2021-04-08  录用日期：2021-06-20

Received Date: 2021-04-08  Accepted Date: 2021-06-20

基金项目：国家重点研发计划资助项目（2018YFC1311600）；辽宁省中央引导地方科技发展专项（2019JH6/10400006）；中国医科大学 2019 年度临床医学培育学科支持计划（妇产科学 - 机器人）；中国医科大学国际水平项目（2019 年）

Foundation Item: National Key R&D Program of China (2018YFC1311600); Special Project for Central Guidance of Local Science and Technology Development of Liaoning Province (2019JH6/10400006); 2019 Cultivating Subject Support Program for Clinical Medicine (Obstetrics and Gynecology-Robotics) in China Medical University; 2019 International Level Project of China Medical University

通讯作者：张颐，Email：syzi@163.com

Corresponding Author: ZHANG Yi, Email: syzi@163.com

引用格式：黎金婷，芦恩婷，田东立，等 . 体质量指数对机器人辅助腹腔镜全子宫切除术的影响 [J]. 机器人外科学杂志（中英文）， 2022，3（1）：42-47.

Citation: LI J T, LU E T, TIAN D L, et al. Influence of body mass index on robot-assisted laparoscopic hysterectomy[J]. Chinese Journal of Robotic Surgery,  2022, 3(1): 42-47.

[1] 武爱芳 , 杨树君 , 尹格平 , 等 . 机器人辅助腹腔镜手术在妇科肿瘤中的应用体会 [J].腹腔镜外科杂志 , 2020, 25(11): 866-869, 873.

[2] 陈必良 . 机器人妇产科手术学 [M]. 西安 : 西安交通大学出版社 , 2015: 81-85.

[3] 谭先杰 , 吴鸣 , 马水清 . 改良腹腔镜子宫切除术的临床结局 [J]. 协和医学杂志 , 2011, 2(2): 134-138.

[4] 王海波 , 李苓妙 , 胡晓丽 , 等 . 肥胖妇女腹腔镜全子宫切除术并发症比较与风险评估 [J]. 解放军医药杂志 , 2019, 31(8): 66-69.

[5] 陈陆棠 . 下肢深静脉血栓形成的危险因素及多普勒超声诊断价值分析 [J]. 影像研究与医学应用 , 2020, 4(5): 180-182.

[6] Siedhoff M T, Carey E T, Findley A D, et al. Effect of extreme obesity on outcomes in laparoscopic hysterectomy[J]. Journal of Minimally Invasive Gynecology, 2012, 19(6): 701-707.

[7] Khavanin N, Lovecchio F C, Hanwright P J, et al. The influence of BMI on perioperative morbidity following abdominal hysterectomy[J]. American Journal of Obstetrics & Gynecology, 2013, 208(6): 449.e1-449.e6.

[8] Päivi K, Philipp H, Florian H, et al. Implementation of robot-assisted gynecologic surgery for patients with low and high BMI in a German gynecological cancer center[J]. Archives of Gynecology and Obstetrics, 2014, 290(1): 143-148. 

[9] Gracia M, García-Santos J, Ramirez M, et al. Value of robotic surgery in endometrial cancer by body mass index[J]. International Journal of Gynecology & Obstetrics, 2020, 150(3): 398-405. 

[10] Brunes M, Johannesson U, Hbel H, et al. Effects of obesity on peri-and postoperative outcomes in patients undergoing robotic vs. conventional hysterectomy[J]. The Journal of Minimally Invasive Gynecology, 2021, 28(2): 228-236.

[11] Rebeles S A, Muntz H G, Wieneke-Broghammer C, et al. Robot-assisted total laparoscopic hysterectomy in obese and morbidly obese women[J]. Journal of Robotic Surgery, 2009, 3(3): 141.