背景:肥胖可能通过限制可视化和增加围手术期并发症的风险来增加腹部手术患者的手术复杂性。术前体重和肝脏体积的减少可以改善手术结果。我们研究的目的是评估腹腔镜手术前低热量饮食(LCD)与极低热量饮食(VLCD)在减轻体重和肝脏体积方面的功效。
方法:使用以下纳入标准进行了系统搜索:使用VLCD或LCD进行术前体重减轻的肥胖患者,评估肝脏体积减少,以及在饮食之前和之后使用成像方式。
结果:本系统综述和荟萃分析共纳入了来自21项不同研究的814例患者,544名女性患者(66.8%),平均年龄在24至54岁之间。总平均体重减轻6.42%,平均肝脏体积减少16.7%。荟萃分析表明,术前饮食(LCD或VLCD)可显着降低体重[SMD=-0.68;95%CI(-0.93,-0.42),I2=82%,p≤0.01]和肝脏体积[SMD=-2.03;95%CI(-4.00,-0.06),I2=94%,p≤0.01]。当单独评估时,VLCD导致体重显着减轻[SMD=-0.79;CI(-1.24;-0.34),p≤0.01,I2=90%],LCD[SMD=-0.60;CI(-0.90;-0.29),p≤0.01,I2=68%)。同样,VLCD后肝脏体积显着减少[SMD=-1.40;CI(-2.77,-0.03),p≤0.01,I2=96%],和LCD[SMD=-2.66;CI(-6.13,0.81),p≤0.01,I2=93%]。然而,两种治疗方案之间无显著差异.
结论:术前限制性热量饮食可有效降低腹腔镜手术前的体重和肝脏体积。虽然VLCD在减少体重和肝脏体积方面比LCD更好,差异不显著。
BACKGROUND: Obesity may increase surgical complexity in patients undergoing abdominal surgery by limiting visualization and increasing the risk of peri-operative complications. A preoperative reduction in weight and liver volume may improve surgical outcomes. The aim of our study was to evaluate the efficacy of a low-calorie diet (LCD) versus a very low-calorie diet (VLCD) in reducing weight and liver volume prior to laparoscopic surgery.
METHODS: A systematic search was conducted using the following inclusion criteria: obese patients undergoing preoperative weight loss using a VLCD or LCD, evaluation of liver volume reduction, and the use of an imaging modality before and after the diet.
RESULTS: A total of 814 patients from 21 different studies were included in this systematic review and meta-analysis, with 544 female patients (66.8%) and a mean age range between 24 and 54 years old. There was a total mean weight loss of 6.42% and mean liver volume reduction of 16.7%. Meta-analysis demonstrated that a preoperative diet (LCD or VLCD) significantly reduced weight [SMD = - 0.68; 95% CI (- 0.93, - 0.42), I2 = 82%, p ≤ 0.01] and liver volume [SMD = - 2.03; 95% CI (- 4.00, - 0.06), I2 = 94%, p ≤ 0.01]. When assessed individually, a VLCD led to significant weight reduction [SMD = - 0.79; CI (- 1.24; - 0.34), p ≤ 0.01, I2 = 90%], as did an LCD [SMD = - 0.60; CI (- 0.90; - 0.29), p ≤ 0.01, I2 = 68%). Similarly, there was a significant reduction in liver volume following a VLCD [SMD = - 1.40; CI (- 2.77, - 0.03), p ≤ 0.01, I2 = 96%], and an LCD [SMD = - 2.66; CI (- 6.13, 0.81), p ≤ 0.01, I2 = 93%]. However, there was no significant difference between the two regimens.
CONCLUSIONS: Preoperative restrictive calorie diets are effective in reducing weight and liver volume prior to laparoscopic surgery. Whilst a VLCD was better than an LCD at reducing both weight and liver volume, the difference was not significant.