RESUMO
Objective:To investigate the clinical efficacy of laparoscopic sleeve gastrectomy (LSG) in obesity patients of different grades.Methods:The retrospective and descriptive study was conducted. The clinical data of 139 obesity patients of different grades who were admitted to the General Hospital of Ningxia Medical University from January 2018 to December 2021 were collected. There were 37 males and 102 females, aged (32±9)years. Of the 139 patients, there were 45 cases of grade Ⅰ obesity, 44 cases of grade Ⅱ obesity and 50 cases of grade Ⅲ obesity, respectively. Obser-vation indicators: (1) intraoperative and postoperative situations in obesity patients of different grades; (2)hematological related indicators in obesity patients of different grades; (3)body quality related indicators in obesity patients of different grades. Measurement data with normal distribution were represented as Mean± SD, and comparison within three groups was conducted using the One-way Anova test and comparison between groups was conducted using the LSD test. Measurement data with skewed distribution were represented as M(range), and comparison within three groups was conducted using the Kruskal-Wallis H test. Count data were described as absolute numbers, and comparison between groups was performed using the chi-square test or Fisher exact probability. Repeated measurement data were analyzed by the repeated ANOVA. Results:(1) Intraoperative and postoperative situations in obesity patients of different grades. The operation time,volume of intraoperative blood loss,duration of postoperative hospital stay and cases readmitted within 30 days after surgery were 2.0(range, 1.5-2.0)hours,50(range, 50-100)mL, 5(range, 4-6)days and 2 in the 45 cases of grade Ⅰ obesity. The above indicators were 2.0(range, 1.5-2.0)hours, 60(range, 50-187)mL, 5(range, 4-6)days and 4 in the 44 cases of grade Ⅱ obesity and 2.0(range, 1.5-2.1)hours, 60(range, 50-135)mL, 5(range, 4-7)days and 4 in the 50 cases of grade Ⅲ obesity. There was no significant difference in the operation time, volume of intraoperative blood loss,duration of postoperative hospital stay among the three groups of patients ( H=4.11, 0.77, 3.59, P>0.05) and there was no significant difference in cases readmitted within 30 days after surgery among the three groups of patients ( P>0.05). (2) Hematological related indicators in obesity patients of different grades. All 139 patients were followed up at postoperative 3, 6 and 12 month. The total cholesterol (TC) were (4.5±0.9)mmol/L, (4.6±0.9)mmol/L, (4.3±0.8)mmol/L, (4.6±1.1)mmol/L at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (4.5±0.8)mmol/L, (4.4±0.8)mmol/L, (4.4±1.0)mmol/L, (4.3±0.9)mmol/L in cases of grade Ⅱ obesity and (4.4±1.0)mmol/L, (4.7±1.1)mmol/L, (4.5±0.8)mmol/L, (4.4±0.5)mmol/L in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=20.81, P<0.05) and results of multi-variate test showed that there was no significant difference in the time effect, intergroup effect and interaction effect of TC among the three groups( Ftime=0.45, Fgroup=0.40, Finteraction=0.66, P>0.05). The triglyceride (TG) were (2.0±1.1)mmol/L, (1.3±0.4)mmol/L, (1.0±0.4)mmol/L, (1.0±0.4)mmol/L at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (2.2±1.1)mmol/L, (1.5±0.5)mmol/L, (1.1±0.3)mmol/L, (1.0±0.3)mmol/L in cases of grade Ⅱ obesity and (2.3±1.1)mmol/L, (1.7±0.7)mmol/L, (1.4±0.6)mmol/L, (1.2±0.4)mmol/L in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=290.49, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of TG among the three groups ( Ftime=80.44, Fgroup=4.13, Finteraction=2.67, P<0.05). The vitamin D were (12.9±5.9)μg/L, (16.5±5.9)μg/L, (18.0±6.3)μg/L, (20.1±5.7)μg/L at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (11.5±4.4)μg/L, (17.1±5.0)μg/L, (18.2±5.6)μg/L, (20.2±6.6)μg/L in cases of grade Ⅱ obesity and (9.8±3.5)μg/L, (17.2±4.6)μg/L, (18.1±4.7)μg/L, (19.5±5.2)μg/L in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=53.07, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect and interaction effect of vitamin D among the three groups ( Ftime=150.88, Finteraction=3.86, P<0.05)and there was no significant difference in the intergroup effect of vitamin D among the three groups ( Fgroup=0.35, P>0.05). (3) Body quality related indicators in obesity patients of different grades. The body mass and body mass index (BMI) were (88±8)kg, (71±8)kg, (65±8)kg, (61±7)kg, (32±2)kg/m 2, (26±2)kg/m 2, (24±2)kg/m 2, (22±2)kg/m 2 at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were (106±11)kg, (82±8)kg, (75±9)kg, (70±9)kg, (37±1)kg/m 2, (29±2)kg/m 2, (26±2)kg/m 2, (25±3)kg/m 2 in cases of grade Ⅱ obesity and (131±20)kg, (101±15)kg, (89±13)kg, (79±12)kg, (45±6)kg/m 2, (35±5)kg/m 2, (31±4)kg/m 2, (27±4)kg/m 2 in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=194.60, 179.52, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of body mass and BMI among the three groups( Ftime=492.59, 543.86, Fgroup=89.13, 95.91, Finteraction=13.97, 13.32, P<0.05). The percen-tage of excess weight loss (EWL%) were 61%±16%,84%±21%,96%±23% at postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were 55%±7%,72%±16%,85%±19% in cases of grade Ⅱ obesity and 45%±12%,64%±15%,78%±7% in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=51.61, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect and intergroup effect of EWL% among the three groups ( Ftime=374.52, Fgroup=15.69, P<0.05) and there was no significant difference in the interaction effect of EWL% among the three groups ( Finteraction=1.08, P>0.05). The percentage of total body weight loss (TWL%) were 19%±5%, 26%±6%, 30%±6% at postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indicators were 21%±6%, 29%±6%, 34%±7% in cases of grade Ⅱ obesity and 22%±7%, 32%±7%, 39%±8% in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2=58.54, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of TWL% among the three groups ( Ftime=290.61, Fgroup=12.32, Finteraction=5.49, P<0.05). The waist to hip ratio (WHR) and visceral fat area (VFA) were 0.92±0.04, 0.86±0.03, 0.84±0.03, 0.83±0.03, (129±19)cm 2, (79±17)cm 2, (63±15)cm 2, (57±14)cm 2 at preoperative and postoperative 3, 6 and 12 month in cases of grade Ⅰ obesity. The above indi-cators were 0.98±0.05, 0.90±0.05, 0.87±0.05, 0.86±0.05, (169±20)cm 2, (105±23)cm 2, (85±20)cm 2, (73±20)cm 2 in cases of grade Ⅱ obesity and 1.05±0.09, 0.94±0.06, 0.91±0.06, 0.89±0.05, (218±42)cm 2, (144±35)cm 2, (114±26)cm 2, (96±19)cm 2 in cases of grade Ⅲ obesity. The above indicators among the three groups not meeting the mauchly′s test of sphericity ( χ2 =289.99, 191.92, P<0.05) and results of multi-variate test showed that there were significant differences in the time effect, intergroup effect and interaction effect of WHR and VFA among the three groups ( Ftime=361.39, 707.60, Fgroup=34.28, 12.69, Finteraction=8.31, 94.89, P<0.05). Conclusion:Treatment of obesity patients of different grades with LSG can improve patients′ TG and vitamin D levels, and reduce patients′ body mass, BMI, EWL%, TWL%, WHR and VFA.
RESUMO
Objective:To investigate the influence of perioperative oral nutritional supple-mentation on short-term efficacy of laparoscopic sleeve gastrectomy (LSG) for obesity patients.Methods:The prospective study was conducted. The clinical data of 218 obesity patients who underwent LSG in the General Hospital of Ningxia Medical University from January 2018 to December 2021 were selected. Patients receiving perioperative oral nutritional supplementation were allocated into the experiment group, and patients receiving perioperative conventional treatment were allo-cated into the control group, respectively. Observation indicators: (1) grouping situations of the enrolled patients; (2) postoperative situations and follow-up; (3) nutrition related indicators; (4) dietary compliance; (5) weight loss related indicators. Follow-up was conducted using telephone interview, WeChat communication and outpatient examination to detect albumin (ALB), hemoglobin (HB), dietary compliance and weight loss related indicators of patients up to February 2022. Patients were followed up once every 30 days after discharge. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the indepen-dent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was performed using the chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Comparison of ordinal data was analyzed using the rank sum test. Results:(1) Grouping situations of the enrolled patients. A total of 218 patients were selected for eligibility. There were 42 males and 176 females, aged (32±9)years with body mass index (BMI) as (39±7)kg/m 2. Of the 218 patients, there were 109 patients in the experiment group and 109 patients in the control group. Gender(male, female), age, BMI, preoperative albumin (Alb), preoperative hemoglobin (Hb) were 17, 92, (33±9)years, (39±7)kg/m 2, (40.6±4.8)g/L, (141.7±13.9)g/L in the experiment group, versus 25, 84, (31±8)years, (39±8)kg/m 2, (40.9±4.2)g/L, (142.9±9.7)g/L in the control group, showing no signifi-cant difference in the above indicators between the two groups ( χ2=1.89, t=?1.52, 0.51, 0.40, 0.71, P>0.05). (2) Postoperative situations and follow-up. The duration of initial hospital stay, the cost of initial hospital stay were (9.1±2.9)days, (3.6±0.5)ten thousand yuan in the experiment group, versus(11.6±3.7)days, (4.9±1.0)ten thousand yuan in the control group,showing significant differences in the above indicators between the two groups ( t=5.58, 12.38, P<0.05). Of the 218 patients,119 patients were followed up,including 62 patients in the experiment group and 57 patients in the control group,with the follow up time as 31.0(range, 25.0?38.0)days. Of the 218 patients, 14 cases were read-mitted for postoperative complications. There were 2 cases in the experiment group including 1 case with nausea and vomiting and 1 case with ileus, and there were 12 cases in the control group including 10 cases with nausea and vomiting and 2 cases with gastric fistula. There was a significant difference in the readmission between the two groups ( χ2=7.63, P<0.05). The interval between readmission and initial discharge of the 14 patients was(22.0±6.7)days. (3) Nutrition related indica-tors. The Alb and Hb of the 62 patients being followed up in the experiment group were (40.4±5.5)g/L, (35.9±3.8)g/L, (45.4±2.9)g/L and (140.8±13.9)g/L, (130.5±16.9)g/L, (147.8±17.2)g/L before opera-tion, before the first discharge and one month after operation, respectively. The above indicators of the 57 patients being followed up in the control group were (41.2±3.9)g/L, (34.2±3.9)g/L, (42.7±5.3)g/L and (143.0±9.7)g/L, (122.9±12.8)g/L, (139.0±11.4)g/L before operation, before the first discharge and one month after operation, respectively. There were significant differences in change trends of Alb and Hb before operation to one month after operation between the two groups ( Fgroup=4.27, 5.72, P<0.05). There were significant differences in Alb and Hb before operation to one month after operation between the two groups ( Ftime=187.46, 85.13, P<0.05). There were interaction effects in change trends of Alb and Hb before operation to one month after operation between the two groups ( Finteraction=7.25, 9.13, P<0.05). Results of individual effect shown that there was no significant difference in the intervention effect of Alb and Hb before operation between the two groups ( t=?0.90, ?0.99, P>0.05), and there were significant differences in the intervention effect of Alb and Hb before the first discharge and one month after operation ( t=2.45, 3.34, 2.75, 3.34, P<0.05). (4) Dietary compliance. Cases with dietary complete compliance, partial compliance, non-compliance of the 62 patients being followed up in the experiment group were 28, 19, 15, respectively. The above indicators of the 57 patients being followed up in the control group were 17, 16, 24, respectively. There was a signifi-cant difference in the dietary compliance between the two groups ( Z=?2.14, P<0.05). (5) Weight loss related indicators. The body mass, body fat mass, skeletal muscle mass, body fat ratio, waist hip fat ratio, visceral fat area of the 62 patients being followed up in the experiment group were (111.0±23.0)kg, (50.0±15.0)kg, (34.0±7.0)kg, 45%±6%, 0.99±0.08, (178±53)cm 2, respectively, before opera-tion. The above indicators of the 57 patients being followed up in the control group were (108.0±22.0)kg, (49.0±13.0)kg, (33.0±7.0)kg, 45%±5%, 0.98±0.09, (174±51)cm 2, respectively, before opera-tion. There was no significant difference in the above indicators between the two groups ( t=?0.71, ?0.48, ?1.04, 0.70, ?0.80, ?0.46, P>0.05). The body mass loss, body fat mass loss, skeletal muscle mass loss, body fat ratio loss, waist hip fat ratio loss, visceral fat area loss of the 62 patients being followed up in the experiment group were 13.8(range, 11.8?16.5)kg, 7.5(range, 6.3?10.1)kg, 3.4(range, 2.5?4.6)kg, 2.05%(range, 1.19%?3.21%), 0.04(range, 0.03?0.06), 31.5(range, 24.4?41.0)cm 2, respectively, one month after operation. The above indicators of the 57 patients being followed up in the control group were 10.8(range, 8.5?13.1)kg, 5.9(range, 4.8?8.0)kg, 4.0(range, 3.0?5.2)kg, 2.0%(range, 0.75%?3.20%), 0.04(range, 0.03?0.05), 29.1(range, 21.8?37.9)cm 2, respectively, one month after operation. There were significant differences in the body mass loss and body fat mass loss between the two groups ( Z=?4.99, ?3.54, P<0.05), and there was no significant difference in skeletal muscle mass loss, body fat ratio loss, waist hip fat ratio loss, visceral fat area loss between the two groups ( P>0.05). Conclusion:Perioperative supplement of oral nutritional can reduce the incidence of post-operative complications and readmission and enhance the postoperative nutritional status and short-term efficacy of obesity patients undergoing LSG.