切换至 "中华医学电子期刊资源库"
高级检索
中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2020, Vol. 07 ›› Issue (01) : 41 -45. doi: 10.3877/ cma.j.issn.2095-8765.2020.01.004

所属专题： 文献；

论著

腹腔镜袖状胃切除术联合食管裂孔疝修补术在治疗肥胖合并胃食管反流病的应用价值
艾克拜尔·艾力1, 皮尔地瓦斯·麦麦提玉素甫2, 阿巴伯克力·乌斯曼2, 买买提·依斯热依力2, 赛甫丁·艾比布拉2, 李义亮3, 伊比提哈尔·买买提艾力2, 蒋媛2, 赛米·赛麦提2, 克力木·阿不都热依木1,†()   
  1. 1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院微创，疝和腹壁外科；830001　乌鲁木齐，新疆维吾尔自治区普外微创研究所
    2. 830001　乌鲁木齐，新疆维吾尔自治区人民医院微创，疝和腹壁外科
    3. 830001　乌鲁木齐，新疆维吾尔自治区人民医院微创，疝和腹壁外科1；830001　乌鲁木齐，新疆维吾尔自治区普外微创研究所
  • 收稿日期:2019-11-15 出版日期:2020-02-15
  • 通信作者: 克力木·阿不都热依木
  • 基金资助:
    新疆维吾尔自治区引进高层次人才天池百人计划项目(201939)

Application of laparoscopic sleeve gastrectomy combined with esophageal hiatal hernia repair in the treatment of obesity combined with gastroesophageal reflux disease

Aikebaier·Aili1, Pierdiwasi·Maimaitiyusufu2, Ababokeli·Wusiman2, Maimaiti·Yisireyili2, Saifuding·Aibibula2, Liyiliang3, Yibitihaer·Maimaitiaili2, Jiangyuan2, Saimi·Saimaiti2, Kelimu·Abudureyimu1,†()   

  1. 1. Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery; Research Institute of General and Minimally Invasive Surgery, People's Hospital of Xinjiang Uygur Autunomous Region, Urumqi 830001, China
    2. Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery
  • Received:2019-11-15 Published:2020-02-15
  • Corresponding author: Kelimu·Abudureyimu
  • About author:
    Corresponding author: Kelimu·Abudureyimu, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

艾克拜尔·艾力, 皮尔地瓦斯·麦麦提玉素甫, 阿巴伯克力·乌斯曼, 买买提·依斯热依力, 赛甫丁·艾比布拉, 李义亮, 伊比提哈尔·买买提艾力, 蒋媛, 赛米·赛麦提, 克力木·阿不都热依木. 腹腔镜袖状胃切除术联合食管裂孔疝修补术在治疗肥胖合并胃食管反流病的应用价值[J]. 中华胃食管反流病电子杂志, 2020, 07(01): 41-45.

Aikebaier·Aili, Pierdiwasi·Maimaitiyusufu, Ababokeli·Wusiman, Maimaiti·Yisireyili, Saifuding·Aibibula, Liyiliang, Yibitihaer·Maimaitiaili, Jiangyuan, Saimi·Saimaiti, Kelimu·Abudureyimu. Application of laparoscopic sleeve gastrectomy combined with esophageal hiatal hernia repair in the treatment of obesity combined with gastroesophageal reflux disease[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2020, 07(01): 41-45.

目的

评估腹腔镜袖状胃切除术（LSG）联合食管裂孔疝修补术（HHR）在治疗肥胖合并胃食管反流病（GERD）减重和抗反流的应用价值。

方法

回顾性分析2017年1月至2019年1月在新疆维吾尔自治区人民医院微创，疝和腹壁外科住院接受LSG联合HHR的43例肥胖合并GERD患者的临床资料。其中，男性26例，女性17例；年龄20~55岁，平均年龄（35.6±10.5）岁；体重103~170 kg、平均体重（123.2±17.0）kg；体质量指数（BMI）BMI 31.5~60.2kg/m2、平均BMI（42.3±6.2）kg/m2。记录患者术前和术后6月至12月随访的体重、（BMI）、多余体重减轻率（EWL）、腹围、GerdQ量表评分及测压测酸中的酸反流时间、酸反流次数、食管下括约肌（LES）静息压力、DeMeester评分等指标。计量资料以均数±标准差（±s）表示，术前与术后的比较采用配对t检验。

结果

术后体重从（123.2±17.0）kg降到（89.1±13.5）kg，BMI从（42.3±6.2）kg/m2降到（30.6±5.2）kg/m2，腹围从（129.7±13.3）cm降到（102.3±9.8）cm，与术前相比差异均有统计学意义（n=43，t=22.531、23.331、24.623，P＜0.05）；术后EWL为（65.8±15.7）%；酸反流时间从（182.8±118.5）min降到（105.2±62.5）min，酸反流次数从（103.7±70.4）降到（30.5±12.2）次，LES静息压力从（17.0±14.2）mmHg（1 mmHg=0.133 kPa）升到（30.1±14.9）mmHg，DeMeester评分从（24.2±18.2）分降到（9.7±4.1）分，GerdQ评分从（11.5±1.8）分降到（7.4±1.0）分，与术前相比差异均有统计学意义（n=43，t=8.226、8.447、-17.259、6.142、14.788，P＜0.05）。

结论

LSG联合HHR在肥胖合并GERD患者的治疗中安全、可行，同时可达到减重和抗反流作用，其近期疗效显著、确切，可适用于肥胖合并GERD的诊疗中，长期疗效需要进一步观察研究。

关键词: 腹腔镜袖状胃切除术, 食管裂孔疝修补术, 肥胖, 胃食管反流疾病, 疗效
Objective

To analyze the application of weight loss and anti-reflux outcomes of laparoscopic sleeve gastrectomy (LSG) with esophageal hiatal hernia repair(HHR) method in the treatment of obesity combined with gastroesophageal reflux disease(GERD).

Methods

A retrospective analyze was made on 43 obese with GERD who underwent LSG combined with HHR treatment from January 2017 to January 2019 in the our hospital were collected as a study group. We recorded the clinical data, including： body weight, BMI, excess weight loss rate(EWL), waist circumference, GerdQ, acid reflux time, acid reflux number, LES resting pressure, DeMeester score；analyzed the above data before and after surgery, and follow up for 6 to 12 month.

Results

After surgery, body weight decreased from (123.2±17.0) kg to (89.1±13.5) kg, BMI decreased from (42.3±6.2) kg/m2 to (30.6±5.2) kg/m2, waist circumference decreased from (129.7±13.3) cm to (102.3±9.8) cm, the difference was statistically significant (P＜0.05), EWL is 65.8±15.7%; acid reflux time decreased from (182.8±118.5) min to (105.2±62.4) min, acid reflux number decreased from (103.7±70.4) to (30.5±12.2), LES resting pressure increased from (17.0±14.2) mmHg to (30.1±14.9) mmHg, DeMeester score decreased from (24.2±18.2) to (9.7±4.1), GERD-Q decreased from (11.5±1.8) to (7.4±1.0), the difference were statistically significant (P＜0.05)；

Conclusion

The short-term efficacy of LSG with HHR in the treatment of obese with GERD was clear, safe, reliable, and feasible. It can not only effectively reduce weight but also improve GERD ocurrence. Its long-term efficacy needs further investigation.

Key words: Laparoscopic sleeve gastrectomy, Hiatal hernia repair, Obesity, Gastroesophageal reflux disease, Efficacy
表1 术后减重指标的变化情况
时间 体重（kg） BMI（kg/m2） 腹围（cm） EWL（%）
术前 123.2±17.0 42.3±6.2 129.7±13.3
术后 89.1±13.5 30.6±5.2 102.3±9.8 65.8±15.7
t 值 22.531 23.331 24.623
P 值 ＜0.001 ＜0.001 ＜0.001
表2 术后GERD指标的变化情况
时间

反流次数

/（次）

反流时间

/（min）

LESRP

（mmHg）

DeMeester

评分

Gerd

评分
术前 103.7±70.4 182.8±118.5 17.0±14.2 24.2±18.2 11.5±1.8
术后 30.5±12.2 105.2±62.5 30.1±14.9 11.1±6.0 7.4±1.0
t 值 8.447 8.226 -17.259 6.142 14.788
P 值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
1
Soricelli E, Casella G, Rizzello M, et al. Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy [J]. Obes Surg, 2010, 20(08): 1149-1153.
2
Braghetto I, Lanzarini E, Korn O, et al. Manometric changes of the lower esophageal sphincter after sleeve gastrectomy in obese patients [J]. Obes Surg, 2010, 20(03): 357-362.
3
Che F, Nguyen B, Cohen A, et al. Prevalence of hiatal hernia in the morbidly obese [J]. Surg Obes Relat Dis, 2013, 09(06): 920-924.
4
Sutherland V, Kuwada T, Gersin K, et al. Impact of bariatric surgery on hiatal hernia repair outcomes [J]. Am Surg, 2016, 82(08): 743-747.
5
Weber C, Davis C S, Shankaran V, et al. Hiatal hernias: a review of the pathophysiologic theories and implication for research [J]. Surg Endosc, 2011, 25(10): 3149-3153.
6
Boza C, Daroch D, Barros D, et al. Long-term outcomes of laparoscopic sleeve gastrectomy as a primary bariatric procedure [J]. Surg Obes Relat Dis, 2014, 10(06): 1129-1133.
7
Pareek M, Schauer PR, Kaplan LM, et al. Metabolic surgery: weight loss, diabetes, and beyond [J]. J Am Coll Cardiol, 2018, 71(06): 670-687.
8
Dimitrokallis N, Alexandrou A, Schizas D, et al. Single-incision laparoscopic sleeve gastrectomy: review and a critical appraisal [J]. J Laparoendosc Adv Surg Tech A, 2017, 27(03): 217-226.
9
Arman GA, Himpens J, Dhaenens J, et al. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy [J]. Surg Obes Relat Dis, 2016, 12(10): 1778-1786.
10
Melissas J, Braghetto I, Molina JC, et al. Gastroesophageal Reflux Disease and Sleeve Gastrectomy [J]. Obes Surg, 2015, 25(12): 2430-2435.
11
El CM, Ezeji G, Claros L, et al. Short-term results of laparoscopic sleeve gastrectomy in combination with hiatal hernia repair: experience in a single accredited center [J]. Obes Surg, 2016, 26(01): 68-76.
12
Mahawar KK, Carr WRJ, Jennings N, et al. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review [J]. Obesity Surgery, 2015, 25(01): 159-166.
13
Boules M, Corcelles R, Guerron AD, et al. The incidence of hiatal hernia and technical feasibility of repair during bariatric surgery [J]. Surgery, 2015, 158(04): 911-918.
14
Dakour A H, Tamim H, Mailhac A, et al. Concomitant hiatal hernia repair with laparoscopic sleeve gastrectomy is safe: analysis of the ACS-NSQIP database [J]. Surg Obes Relat Dis, 2017, 13(03): 379-384.
15
刘金刚， 郑成竹， 王勇. 中国肥胖和2型糖尿病外科治疗指南（2014） [J]. 中国实用外科杂志， 2014， 34（11）: 1005-1010.
16
陈旻湖， 侯晓华， 肖英莲， 等. 2014年中国胃食管反流病专家共识意见 [J]. 胃肠病学， 2015， 20（03）: 155-168.
17
Stenard F, Iannelli A. Laparoscopic sleeve gastrectomy and gastroesophageal reflux [J]. World J Gastroenterol, 2015, 21(36): 10348-10357.
18
Petersen WV, Meile T, Kuper MA, et al. Functional importance of laparoscopic sleeve gastrectomy for the lower esophageal sphincter in patients with morbid obesity [J]. Obes Surg, 2012, 22(03): 360-366.
19
Che F, Nguyen B, Cohen A, et al. Prevalence of hiatal hernia in the morbidly obese [J]. Surg Obes Relat Dis, 2013, 09(06): 920-924.
20
Soricelli E, Casella G, Rizzello M, et al. Initial experience with laparoscopic crural closure in the management of hiatal hernia in obese patients undergoing sleeve gastrectomy [J]. Obes Surg, 2010, 20(08): 1149-1153.
21
Oor JE, Roks DJ, Unlu C, et al. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease: a systematic review and meta-analysis [J]. Am J Surg, 2016, 211(01): 250-267.
22
DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis [J]. JAMA Surg, 2014, 149(04): 328-334.
23
Carter PR, LeBlanc KA, Hausmann MG, et al. Association between gastroesophageal reflux disease and laparoscopic sleeve gastrectomy [J]. Surg Obes Relat Dis, 2011, 07(05): 569-572.
24
Tai CM, Huang CK, Lee YC, et al. Increase in gastroesophageal reflux disease symptoms and erosive esophagitis 1 year after laparoscopic sleeve gastrectomy among obese adults [J]. Surg Endosc, 2013, 27(04): 1260-1266.
25
Docimo SJ, Rahmana U, Bates A, et al. Concomitant hiatal hernia repair is more common in laparoscopic sleeve gastrectomy than during laparoscopic roux-en-y gastric bypass: an analysis of 130,772 cases [J]. Obes Surg, 2019, 29(02): 744-746.
26
Chiappetta S, Stier C, Scheffel O, et al. Mini/one anastomosis gastric bypass versus roux-en-y gastric bypass as a second step procedure after sleeve gastrectomy-a retrospective cohort study [J]. Obes Surg, 2019, 29(03): 819-827.
27
Mahawar KK, Carr WR, Jennings N, et al. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review [J]. Obes Surg, 2015, 25(01): 159-166.
28
克力木·阿不都热依木，艾克拜尔·艾力， 伊比提哈尔， 等. 腹腔镜胃底折叠术联合胃袖状切除术治疗肥胖合并胃食管反流病 [J]. 中华普通外科杂志， 2015， 30（06）: 458-461.
29
Soricelli E, Iossa A, Casella G, et al. Sleeve gastrectomy and crural repair in obese patients with gastroesophageal reflux disease and/or hiatal hernia [J]. Surg Obes Relat Dis, 2013, 09(03): 356-361.
30
Santonicola A, Angrisani L, Iovino P. Reply to "Comment on: The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on gastroesophageal reflux disease in obese patients" [J]. Surg Obes Relat Dis, 2014, 10(02): 371-372.
31
Mahawar KK, Carr WR, Jennings N, et al. Simultaneous sleeve gastrectomy and hiatus hernia repair: a systematic review [J]. Obes Surg, 2015, 25(01): 159-166.
32
克力木·阿不都热依木, 皮尔地瓦斯·麦麦提玉素甫, 艾克拜尔·艾力, 等. 腹腔镜手术治疗食管裂孔疝合并缺铁性贫血26例临床报告 [J]. 中华胃食管反流病电子杂志, 2016, 03(03): 132-134.
[1] 何金梅, 尹立雪, 谭静, 张文军, 王锐, 任梅, 廖明娇. 超声心肌做功技术对2型糖尿病患者潜在左心室心肌收缩功能损伤的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1029-1035.
[2] 张华, 孙宇, 乡世健, 李樱媚, 王小群. 循环肿瘤细胞预测晚期胃肠癌患者化疗药物敏感性的研究[J]. 中华普通外科学文献(电子版), 2023, 17(06): 422-425.
[3] 纪凯伦, 郝少龙, 孙海涛, 韩威. 减重术后胆囊结石形成机制的新进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 100-103.
[4] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[5] 陈大敏, 曹晓刚, 曹能琦. 肥胖对胃癌患者手术治疗效果的影响研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 651-653.
[6] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[7] 唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[8] 李晓晖, 上官昌盛, 向英, 裴芝皆, 车俊志, 谢飞. 3D腹腔镜袖状胃切除术后机体能量代谢与多囊卵巢综合征患者性激素水平关系[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 538-541.
[9] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[10] 邰清亮, 施波, 侍新宇, 陈国梁, 陈俊杰, 武冠廷, 王索, 孙金兵, 顾闻, 叶建新, 何宋兵. 腹腔镜次全结肠切除术治疗顽固性慢传输型便秘的疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 478-483.
[11] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
[12] 梁文龙, 曹杰, 黄庆, 林泳, 黄红丽, 杨平, 李冠炜, 胡鹤. 信迪利单抗联合瑞戈非尼治疗晚期结直肠癌的疗效与安全性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 409-413.
[13] 高显奎, 赵太云, 陆兴俊, 张洪领, 房修罗, 闫碧春, 王胤, 王永翠, 刘苗苗, 冉若男. 内镜电凝止血与组织胶注射治疗上消化道溃疡伴出血的疗效观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 452-455.
[14] 姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
[15] 李莹倩, 李华山. 基于真实世界的完全性直肠脱垂治疗方式评价[J]. 中华临床医师杂志(电子版), 2023, 17(06): 700-705.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号