Effect Analysis Of Laparoscopic Sleeve Gastrectomy In The Treatment Of Obesity Complicated With Nonalcoholic Fatty Liver Disease

Objective:To investigate the clinical effect of laparoscopic sleeve gastrectomy（LSG）on obese patients with nonalcoholic fatty liver disease（NAFLD）.Methods:The clinical data of 86 obese patients with NAFLD who underwent LSG in the Department of general surgery of Cangzhou people’s Hospital from January 2016 to December 2019 were retrospectively analyzed.The patients were followed up for 12 months,and the relevant data were recorded before the operation and at 1,3,6 and 12 months after operation,including:1,Anthropometric indexes:body weight,body mass index（BMI）and percentage of excess weight loss（EWL%）.2,Liver function indexes:alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,andγ-glutamyl transpeptidase（GGT）.3,Lipid metabolism indexes:total cholesterol（TC）,triacylglycerol（TG）,high density lipoprotein cholesterol（HDL-C）and low density lipoprotein cholesterol（LDL-C）;The degree of fatty liver and CT value of liver and spleen（CTL/S）as was shown by plain abdominal CT scan before and 12 months after surgery were also recorded.Objective to compare and analyze the changes of various indexes and the remission of fatty liver before and after the operation,so as to explore the clinical therapeutic effect of LSG on obese patients with NAFLD.Spss23.0 software was used for statistical analysis and the difference was statistically significant when P value<0.05.Results:All patients successfully completed the operation,no conversion to laparotomy,bleeding,gastric leakage or wound infection and other complications,and successfully completed the postoperative follow-up.Compared with preoperative,the body weight,BMI,ALT,AST,GGT,TC,TG,LDL-C levels of obese patients at 1 month,3 months,6 months and 12months after operation decreased significantly（P<0.05）,EWL%increased gradually（P<0.05）,and HDL-C increased significantly（P<0.05）.The effective rate of weight loss at 12 months after operation was 97.67%.Preoperative CT results showed that there were 86 cases of NAFLD patients,including 45cases of light,33 cases of medium and 8 cases of heavy fatty liver respectively.In the 12th month after operation,71 cases of fatty liver completely returned to normal and there were also 14 cases of light,1 case of medium and 0 cases of heavy fatty liver respectively;All patients were significantly relieved compared with preoperation,and the total remission rate was 100%,of which the significant efficiency rate and efficiency rate were89.53%and 10.47%respectively.The average CTL/S was（0.72±0.13）preoperatively and（1.01±0.09）at 12 months postoperatively.There was significant difference between preoperation and 12 months postoperatively（P<0.05）.CTL/S was negatively correlated with BMI,ALT,AST,GGT,TC and TG（r₁=-0.238,r₂=-0.551,r₃=-0.220,r₄=-0.220,r₅=-0.230,r₆=-0.422,P<0.05）.Conclusion:LSG is a safe and effective way to reduce weight.It can not only reduce weight effectively,but also significantly relieve or cure NAFLD.At the same time,LSG can significantly improve liver function and dyslipidemia.It is a reliable way to treat obesity with NAFLD and provides a new idea for the treatment and improvement of metabolic syndrome.