| Background:With the development of modern society and change of human lifestyle,the prevalence rate of obesity and type 2 diabetes mellitus(T2DM)increased year by year.They both pose a great threat to human health and have become the global health problem.Bariatric and metabolic surgery is currently recognized as the most effective intervention to treat obesity and it is also an important treatment to improve the abnormal glucose metabolism and treat T2DM.With the gradual maturity of minimally invasive techniques,laparoscopic bariatric and metabolic surgery is increasingly used in clinical practice.Because of its precise effect of reducing weight,relatively simple operation process and low postoperative complication rates,Laparoscopic sleeve gastrectomy(laparoscopic sleeve gastrectomy,LSG)has become the most widely clinical application of bariatric and metabolic surgery.Objective:To obeserve the clinical data and laboratory indexes of obese patients,such as body weight,BMI,blood glucose,EWL%,FBG,PBG,blood triglycerides,in preoperative and postoperative 1 month,3 months,6 months.To evaluate the safety,short-term curative effect of laparoscopic sleeve gastrectomy.Reviewing the relevant literature and combining the surgical experience of the center to discuss the operative points of LSG.Methods:The clinical data and postoperative follow-up data of 25 obese patients who underwent laparoscopic sleeve gastrectomy in qilu hospital of shandong university from June 2015 to February 2017 were retrospectively analyzed.Record the change of the patients with preoperative and postoperative body weight,BMI,EWL%,FBG,PBG and TG.Record the operation time,whether a drainage tube is placed and the pulling out time,postoperative urine tube’s pulling out time,postoperative gastric tube’s pulling out time,the length of postoperative hospital stay,the total length of hospital stay.Statistical analysis was conducted by using Excel and SPSS 22.0 statistical software.Using GraphPad Prism for statistical drawing.Results:Status of operation:all 25 cases of LSG were successfully implemented,no case being converted to open laparotomy,no intraoperative or postoperative death cases were found.The mean operative time was(169.40±39.22)min,and drainage tubes were placed in 2 cases and removed on day 1 after surgery.All patients had gastric tube and urethral catheter removed on the first day after surgery.The mean postoperative hospitalization time is(4.20 ± 1.04)d,and the average total hospitalization time is(10.60 ±2.89)d.Three patients were transferred to ICU after surgery,and all of them were successfully removed from the mechanical supplementary respiration and returned to our department after tracheal intubation was removed.Postoperative complications such as gastric stump hemorrhage,gastroparesis and wound infection were not found.All 25 patients underwent postoperative follow-up of 6 months.Results are as follows:during the first month,mean weight was(108.14±20.21)kg(p<0.05),mean BMI was(36.13±5.10)kg/m2(p<0.05),the mean EWL%was(28.21 ±8.61)%,mean FBG was(4.80±0.76)mmol/L(p<0.05),mean TG was(1.78±0.39)mmol/L(p<0.05);during the third month,mean weight was(94.22 ± 16.86)kg(p<0.05),mean BMI was(31.52 ±4.42)kg/m2(p<0.05),the mean EWL%was(55.96±13.34)%(p<0.05),mean FBG was(4.47±0.59)mmol/L(p<0.05),the mean PBG was(6.16±0.62)mmol/L(p<0.05),mean TG was(1.72 ±0.33)mmol/L(p<0.05);during the sixth month,mean weight was(82.10± 14.41)kg(p<0.05),mean BMI was(27.46±3.62)kg/m2(p<0.05),the mean EWL%was(79.22±14.79)%(p<0.05),mean FBG was(4.36±0.45)mmol/L(p<0.05),the mean PBG was(5.98 ±0.40)mmol/L(p<0.05),mean TG was(1.50 ± 0.34)mmol/L(p<0.05);Compared with preoperative status,FBG and PBG of 6 diabetic patients were significantly decreased in postoperative follow-up.After 6 months,all the patients with obesity associated diseases benefited from the surgery and got different degrees of remission and improvement.There was no postoperative hospitalization or reoperation.Conclusion:Laparoscopic sleeve gastrectomy is a safe and effective method to reduce weight.The entire operation did not change the physiological structure of the gastrointestinal tract and the postoperative complications were less.The patient was discharged from hospital after operation in a short time and the recovery of diet was fast.LSG could achieve distinct curative effect for the obesity in the short term.At the same time for obesity associated diseases,especially T2DM,it is also a good way to get relief.Some patients can even achieve complete remission.However,for the long term,the curative effect of this surgery still need further follow-up and further clinical data analysis results to support. |
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