【 文献重点摘要 】
 

Background: Gender affirmation surgery (GAS) has a positive impact on the health of transgender patients; however, some centers employ body mass index (BMI) as a strict selection criterion for surgical candidacy. Several single-center studies have found no clear correlation between BMI and complication rates. We conducted a retrospective multicenter study at 2 university-based centers to test the null hypothesis: obesity is not a significant determinant of the risk of acute surgical complications in patients undergoing penile inversion vaginoplasty (PIV).

Methods: This is a retrospective chart review of all adult patients at the University of Michigan and the University of Miami undergoing gender-affirming PIV with minimum follow-up time of 3 months between 1999 and 2017. A logistic regression model of analysis is used to examine the predictive factors for surgical complications and delayed revision urethroplasty in our patient sample.

Results: One hundred and one patients met inclusion criteria for this study. The mean BMI at the time of procedure was 26.9kg/m2 (range 17.8–48.2). Seventeen patients (16.8%) had major complications and 36 patients (35.6%) had minor complications. On logistic regression analysis, none of the recorded covariates were significant predictors of delayed revision urethroplasty or major, minor, or any complications.

Conclusions: We found that obese patients can safely undergo GAS and that BMI alone should not preclude appropriately selected patients from undergoing GAS. We acknowledge that selection based on overall health and other medical comorbidities is certainly warranted for gender-affirming PIV and all other surgical procedures.

背景：性别肯定手术(GAS)对变性人患者的健康有积极影响；然而，一些中心使用体重指数(BMI)作为手术候选的严格选择标准。多项单中心研究发现，BMI和并发症发生率之间没有明确的相关性。我们在两个基于大学的中心进行了一项回顾性多中心研究，以检验无效假设：肥胖不是阴茎内翻阴道成形术(PIV)患者急性手术并发症风险的重要决定因素。

方法：这是对密歇根大学(University Of Michigan)和迈阿密大学(University Of Miami)在1999年至2017年期间接受性别确认PIV的所有成年患者的回顾性图表审查，最短随访时间为3个月。在我们的患者样本中，使用Logistic回归分析模型来检验手术并发症和延迟尿道翻修术的预测因素。

结果：101名患者符合本研究的纳入标准。术前平均体重指数为26.9 kg/m2(17.8~48.2)。主要并发症17例(16.8%)，轻度并发症36例(35.6%)。在Logistic回归分析中，记录的协变量中没有一个是延迟尿道翻修手术或重大、轻微或任何并发症的显著预测因子。

结论：我们发现肥胖患者可以安全地接受GAS治疗，BMI本身不应排除适当选择的患者接受GAS治疗。我们认识到，基于整体健康和其他医疗合并症的选择对于确认性别的PIV和所有其他外科手术当然是有必要的。