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Objective To investigate the effects of structured triglyceride and long chain triglyceride/medium chain triglyceride (LCT/MCT) on postoperative efficacies of elderly patients (≥70 years old) after total gastrectomy for gastric cancer.Methods The retrospective cohort study was conducted.The clinical data of 42 elderly patients who underwent total gastrectomy for gastric cancer in the Jiangsu Cancer Hospital between Sepember 2014 and September 2015 were collected.Twenty-two patients using structured triglyceride in postoperative parenteral nutrition and 20 using LCT/MCT in postoperative parenteral nutrition were allocated into the case and control groups,respectively.All the patients underwent total gastrectomy + Roux-en-Y esophagojejunostomy.Patients in the case and control groups received respectively 20％ structured triglyceride and 20％ LCT/MCT.Observation indicators:(1) postoperative recovery situation:time of gut exsufflation,changes of body mass at postoperative 5 days,postoperative anastomotic leakage and abdominal infection;(2) test of liver function indexes:aspartate transaminase (AST),alanine transaminase (ALT),total bilirubin (TBil),direct bilirubin (DBil) of liver function in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(3) test of nutritional indexes:serum total protein (TP),albumin (Alb) and prealbumin in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5;(4) test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD3/CD8 in fasting peripheral blood were tested at preoperative day 1 and at postoperative day 1 and 5.Measurement data with normal distribution were represented as x ±s.Repeated measures data were evaluated with the repeated measures ANOVA.Count data were analyzed using the chi-square test and Fisher exact probability.Results (1) Postoperative recovery situation:there was no special adverse reaction during support treatment of parenteral nutrition.Time of gut exsufflation,changes of body mass at postoperative 5 days,incidences of postoperative anastomotic leakage and abdominal infection were (46 ± 12)hours,(60±8) kg,0,0 in the case group and (50 ±14) hours,(58±9)kg,0,1 in the control group,respectively,with no statistically significant difference between the 2 groups (t =0.86,0.65,P＞0.05).(2) Test of liver function indexes:levels of AST and ALT from preoperation to postoperative day 5 were respectively from (24±9) U/L to (22±6)U/L,from (31±12)U/L to (20±8)U/L in the case group and from (23±8) U/L to (30± 10) U/L,from (30 ± 9) U/L to (32 ± 7) U/L in the control group,respectively,with statistically significant differences between the 2 groups (F =92.87,87.92,P＜0.05).Levels of TBil and DBil from postoperative day 1 to postoperative day 5 were respectively from (21±4) μmol/L to (19±4) μmol/L,from (7.0±2.0) μmol/L to (6.0±2.0)μmol/L in the case group and from (19±3) μmol/L to (20±4)μmol/L,from (7.0±2.0)μmol/L to (8.0±3.0)μmol/L in the control group,respectively,with no statistically significant difference between the 2 groups (F =1.48,0.81,P ＞ 0.05).(3) Test of nutritional indexes:levels of serum TP and Alb from postoperative day 1 to postoperative day 5 were respectively from (52±6)g/L to (56±5)g/L,from (34±3)g/L to (37±4) g/L in the case group and from (53±7)g/L to (52±4)g/L,from (33±3) g/L to (31± 3)g/L in the control group,respectively,with no statistically significant difference in changing trends between the 2 groups (F=0.47,0.54,P ＞ 0.05).Levels of prealbumin from postoperative day 1 to postoperative day 5 were respectively from (230±32)mg/L to (245±30)mg/L in the case group and from (228±28)mg/L to (222±26) mg/L in the control group,respectively,with a statistically significant difference in changing trend between the 2 groups (F=16.81,P＜0.05).(4) Test of immunological indexes:levels of IgG and IgA,CD3,CD4 and ratios of CD4/CD8 from postoperative day 1 to postoperative day 5 were respectively from (12±4) g/L,(2.20±0.20)g/L,52％±4％,30％±4％,1.30±0.20 to (18±5)g/L,(2.80±0.30)g/L,59％±4％,33％±4％,1.50±0.20 in the case group and from (12±3)g/L,(2.10±0.10)g/L,52％±4％,27％±4％,1.30±0.10 to (13±4)g/L,(2.30±0.20) g/L,51％±4％,26％ ±4％,1.20±0.20 in the control group,respectively,with statistically significant differences in changing trends between the 2 groups (F=25.07,29.42,33.53,22.19,33.47,P＜0.05).Conclusions The short-term usage of structured triglyceride or LCT/MCT in early period after operation can effectively improve postoperative recovery of elderly patients with gastric cancer,with a small impact on liver function.Structured triglyceride can improve immunologic function and nutrition status more effectively.
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Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP).Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed.A double-blind,randomized,controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/LCT).All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days.The levels of alanine transaminase (ALT),aspartate transaminase (AST),glutamyl-transpeptidase (GGT),alkaline phosphatase (ALP),creatinine (Cr),blood urea nitrogen (BUN),triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1,3 and 5 after nutritional support therapy.The measurement data with normal distribution was presented as (x) ± s.The skew distribution data were described as M (range).The comparison between groups were evaluated with an independent sample t test or one-way ANOVA.The count data were analyzed using the chi-square test.Results A total of 30 patients were screened for eligibility.The levels of ALT,AST,GGT,ALP,Cr,BUN,TG and TC were changed within a certain range at day 1,3 and 5 after nutritional support treatment.The levels of ALT,AST,GGT,ALP,Cr,BUN and TC before treatment and at day 5after treatment were changed from 29.0 U/L,25.4 U/L,83.2 U/L,(193 ± 115) U/L,(124 ± 97) μmol/L,(8±6)mmol/L and (2.4±1.1)mmol/L to 29.4 U/L,33.0 U/L,77.7 U/L,(172±74)U/L,(117 ±103)μmol/L,(8 ± 5) mmol/L and (2.3 ± 1.0) mmol/L in the experimental group,and from 23.8 U/L,22.9 U/L,96.2 U/L,(148 ± 108) U/L,(82 ± 57) μmol/L,(9 ± 7) mmol/L and (2.5 ± 0.7) mmol/L to 21.3 U/L,24.5 U/L,127.4 U/L,(179 ± 126) U/L,(80 ± 54) μmol/L,(10 ± 6) mmol/L and (2.4 ±0.8) mmol/L in the control group,respectively.There were no significant differences in the changing trends of the levels of ALT,AST,GGT,ALP,Cr,BUN and TC between the 2 groups (F =0.647,1.186,0.282,0.553,0.862,0.182,0.369,P＞0.05).The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (1.5 ± 0.7) mmol/L,with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment.The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/L to (2.4 ± 0.6) mmol/L,with increasing trend from pre-treatment to day 1,3 and 5 after treatments.There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F =7.940,P ＜ 0.05).Conclusion STG and physical mixed MCT/LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy,while STG has a better effect of lipometabolism compared with physical mixed MCT/LCT.Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMIN000016958
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Objective To investigate the effects of structured triglyceride on hepatic function,nutritional status,inflammatory reaction and immunologic function of patients with primary liver cancer after hepatectomy.Methods A prospective,double-blind,randomized,controlled clinical trial was conducted based on the clinical data of 80 patients with primary liver cancer who underwent hepatectomy at the Drum Tower Hospital from January 2011 to December 2012.All the 80 patients were allocated into the testing group (40 patients) and the control group (40 patients) based on a random number table,and received isometrical nitrogen and isocaloric parenteral nutritional support therapy for 7 days after operation.Structured triglyceride (STG) and physical mixed medium chain/long chain triglycerides (MCT/LCT) were applied to the patients in the testing group and the control group,respectively.The hepatic function,nutritional status,inflammatory reaction,immunologic function and prognosis of patients were compared between the 2 groups.The measurement data with normal distribution were presented as (x) ± s.The comparision between groups was evaluated with an independent sample t test.The trend analyses for variables were done using the repeated measures ANOVA.The measurement data with skew distribution were described as M(P25,P75) and analyzed by the analysis of variance.The count data were analyzed using the chi-square test.Results All the 80 patients who were screened for eligibility were randomly divided into the testing group (40 patients) and the control group (40 patients).The alanine transaminase (ALT),aspartate transaminase (AST),prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4 +/CD8 + in the 2 groups showed a range of variations before operation and at postoperative day 5 and 7.The ALT,AST,prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4+/CD8 + from preoperation to postoperative day 7 were from (36 ± 10)U/L,(37 ± 13)U/L,(233 ±42)mg/L,(154±32)U/L,(8.1 ±1.6)mg/L,(14±5)g/L,(3.2±1.3)g/L,(2.1 ±1.3)g/L,55.6％±6.8％,37.5％±2.0％,25.9％±2.9％ and 1.5 ±0.5 to (83 ±33)U/L,(63 ±42)U/L,(208 ±37)mg/L,(145 ±26)U/L,(30.3 ±8.6)mg/L,(12 ±3)g/L,(2.8 ±1.6)g/L,(2.0 ±1.2)g/L,46.2％±3.9％,33.4％±3.1％,27.9％±3.0％ and 1.2 ±0.4 in the control group,and from (36 ± 12)U/L,(36 ± 14)U/L,(231 ±45)mg/L,(149 ±25)U/L,(7.6 ± 1.8)mg/L,(13 ±5)g/L,(3.3 ±0.7)g/L,(2.1 ± 1.1)g/L,54.2％±6.3％,37.6％±3.5％,24.8％±3.4％ and 1.5 ±0.4 to (43 ±30)U/L,(40 ±33)U/L,(255 ±44)mg/L,(153 ±27)U/L,(21.7 ±11.2)mg/L,(17 ±4)g/L,(4.1 ± 1.7)g/L,(2.4 ± 1.9)g/L,57.9％±3.2％,39.2％ ± 2.9％ 22.7％ ± 3.4％ and 1.7 ± 0.4 in the testing group,respectively,showing significant differences between the 2 groups (F =94.71,86.40,64.22,16.77,8.18,37.23,11.52,22.58,50.30,26.44,13.16,44.84,P ＜ 0.05).There were no significant differences in the level of ALT,AST,prealbumin,choline esterase,C-reactive protein,IgA,CD8 + and CD4 +/CD8 + at postoperative day 5 between the 2 groups (t =1.24,1.03,0.91,1.02,0.53,0.68,1.61,0.98,P＞0.05).There were significant differences in the IgG,IgM,CD3+and CD4 + at postoperative day 5 between the 2 groups (t =2.58,3.15,3.87,2.46,P ＜ 0.05).There were significant differences in the levels of ALT,AST,prealbumin,choline esterase,C-reactive protein,IgG,IgM,IgA,CD3 +,CD4 +,CD8 + and CD4 +/CD8 + at postoperative day 7 between the 2 groups (t =4.83,2.79,5.58,2.12,3.10,2.53,4.17,2.35,3.45,2.98,3.12,3.75,P ＜0.05).The body weight of patients at postoperative day 7 and duration of hospital stay in the control group were (57 ± 6) kg and (9.9 ± 1.5) days,which were significantly different from (61 ± 8) kg and (8.8 ± 1.3) days in the testing group (t =3.67,2.71,P ＜ 0.05).Conclusion Structured triglyceride can effectively improve the recovery of hepatic function,nutrition status and immunologic function and reduce inflammatory reaction for the patients with primary liver cancer after hepatectomy.
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Objective To investigate the application of structured triglyceride (STG) in malignant obstructive jaundice (MOJ) patients after pancreaticoduodenectomy.Methods The records of 21 MOJ patients received pancreaticoduodenectomy in our hospital were retrospectively analyzed.The patients received parenteral nutrition on the first postoperative day, of whom 7 were given STG (STG group) and 14 were given medium and long chain triglyceride (MCT/LCT group).The changes of liver function, lipid profile, albumin, and postoperative complications were compared between the two groups.Results The triglyceride levels in the STG group on the 3rd and 7th postoperative days were significantly lower than those in the MCT/LCT group [3rd day:(1.85 ±0.90) mmol/L vs.(2.18 ±1.41) mmol/L;7th day: (1.62 ±0.78) mmol/L vs.(2.46± 1.62) mmol/L;both P =0.042];the level of high-density lipoprotein on the 7th postoperative day was significantly higher than that in the MCT/LCT group [(0.67 ±0.64) mmol/L vs.(0.45 ±0.15) mmol/L, P =0.046].The albumin in the STG group returned to normal on the 3rd postoperative day, which was significantly higher than that in the MCT/LCT group [(35.50 ±2.91) g/L vs.(30.66 ±5.08) g/L, P =0.048].There were no significant differences in terms of liver function, length of hospital stay, wound healing, systemic inflammatory response syndrome, and infection between the two groups.Conclusions Parenteral nutrition with structured triglyceride after pancreaticoduodenectomy in MOJ patients is tolerable and safe.STG has less influence on lipid metabolism than MCT/LCT does, and can increase albumin level rapidly.