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中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2023, Vol. 10 ›› Issue (01) : 22 -30. doi: 10.3877/cma.j.issn.2095-8765.2023.01.005

论著

腹腔镜袖状胃切除术对胃食管反流病疗效的系统评价与分析
李赞林, 马建惠, 王志†()   
  1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院微创疝与腹壁外科
    830001　乌鲁木齐，新疆维吾尔自治区人民医院中心手术室
    830001　乌鲁木齐，新疆维吾尔自治区人民医院综合外科
  • 收稿日期:2022-08-17 出版日期:2023-02-15
  • 通信作者: 王志

Systematic evaluation and analysis of the efficacy of laparoscopic sleeve gastrectomy for gastroesophageal reflux disease

Zanlin Li, Jianhui Ma, Zhi Wang†()   

  1. Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery; People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    Operating room,People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
    Comprehensive surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
  • Received:2022-08-17 Published:2023-02-15
  • Corresponding author: Zhi Wang
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引用本文：

李赞林, 马建惠, 王志. 腹腔镜袖状胃切除术对胃食管反流病疗效的系统评价与分析[J]. 中华胃食管反流病电子杂志, 2023, 10(01): 22-30.

Zanlin Li, Jianhui Ma, Zhi Wang. Systematic evaluation and analysis of the efficacy of laparoscopic sleeve gastrectomy for gastroesophageal reflux disease[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2023, 10(01): 22-30.

目的

腹腔镜袖状胃切除术（LSG）对胃食管反流病（GERD）患病率的影响尚不清楚。我们的目的是分析LSG对GERD的影响。

方法

制定检索策略，对万方、知网、PubMed、EMbase、The Cochrane Library及Web of Science数据库进行检索，按照纳入标准和排除标准筛选文献，提取纳入文献的相关数据，并对其进行方法学质量评价和Meta分析统计方法来验证。

结果

共纳入11篇文献、1034例患者。Meta分析结果显示，LSG手术后新出现GERD症状的比较差异具有统计学意义（OR=0.39，95% CI：0.26~0.60，P<0.0001），LSG术后新出现的GERD症状较术前明显增多；此外，LSG手术前后GERD-Q评分比较差异具有统计学意义（MD=-0.59，95% CI：-1.07~-0.11，P=0.02<0.05），从森林图可以看出代表合并后效应量的菱形坐落于左侧，提示LSG术后GERD症状明显加重；LSG手术前后24 h pH检测中DeMeester score比较差异具有统计学意义（MD=-11.82，95% CI：-16.27~-7.37，P<0.000 01），从森林图可以看出代表合并后效应量的菱形坐落于左侧，提示LSG术后GERD症状较术前明显加重；LSG手术前后酸反流平均次数比较差异具有统计学意义（MD=-15.71，95% CI：-23.97~-7.44，P=0.0002<0.05），从森林图可以看出代表合并后效应量的菱形坐落于左侧，提示LSG术后酸反流平均次数较术前明显增多；LSG手术前后24 h pH检测中酸反流时间比较差异具有统计学意义（SMD=-1.00，95% CI：-1.38~-0.61，P<0.000 01），从森林图可以看出代表合并后效应量的菱形坐落于左侧，提示LSG术后酸反流时间较术前明显延长；LSG手术前后每日质子泵抑制剂（proton pump inhibitor, PPI）摄入量比较差异具有统计学意（RR=0.41，95% CI：0.23~0.73，P=0.002<0.05），从森林图可以看出代表合并后效应量的菱形坐落于左侧，提示LSG术后每日PPI摄入量较术前明显增多。但是，LSG手术前后GERD症状的变化比较差异具无统计学意义（OR=0.97，95% CI：0.46~2.04，P=0.093>0.05），LSG手术前后GERD症状无明显变化。

结论

由于现有研究测试结果的矛盾性，LSG对GERD患病率的确切影响仍未得到回答。外科医生在选择合适的减肥技术时，应仔细评估术前的GERD症状,以更清楚地确定SG对减肥患者GERD的影响。

关键词: 腹腔镜袖状胃切除术, 胃食管反流病, 系统评价
Objective

The effect of laparoscopic sleeve gastrectomy (LSG) on the prevalence of gastroesophageal reflux disease (GERD) is unclear. Our aim is to analyze the impact of LSG on GERD.

Methods

Make the retrieval strategy, search the Wanfang, Zhiwang, PubMed, EMbase, The Cochrane Library and Web of Science databases, screen the literature according to the inclusion criteria and exclusion criteria, extract the relevant data of the included literature, and carry on the methodological quality evaluation and Meta analysis.

Results

A total of 11 articles and 1034 patients were included. The results of Meta analysis showed that the difference of new GERD symptoms after LSG operation was statistically significant (OR=0.39,95% CI:0.26~0.60), LSG P<0.0001). The number of new GERD symptoms after operation was significantly higher than that before operation. In addition, there was significant difference in GERD-Q score before and after LSG (MD=-0.59, 95% CI:-1.07~-0.11). The rhombus representing the combined effect was located on the left side from the forest map, indicating that the symptoms of GERD were significantly aggravated after LSG. There was significant difference in DeMeester score in 24-hr pH before and after LSG (MD=-11.82,95% CI:-16.27~-7.37, P<0.000 01). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the symptoms of GERD after LSG are significantly more severe than before. There was a significant difference in the average number of acid reflux before and after LSG (MD=-15.71,95% CI:-23.97~-7.44). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the average number of acid reflux after LSG is significantly higher than that before operation. The time of acid reflux detected by 24-hr pH before and after LSG was significantly different (SMD=-1.00,95% CI:-1.38~-0.61 P<0.000 01). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the acid reflux time after LSG is significantly longer than that before operation. The difference of daily PPI intake before and after LSG was statistically significant (RR=0.41,95% CI:0.23~0.73). From the forest map, we can see that the diamond representing the combined effect is located on the left, suggesting that the daily PPI intake after LSG is significantly higher than that before operation. However, there was no significant difference in the changes of GERD symptoms before and after LSG operation (OR=0.97,95% CI:0.46~2.04), LSG 0.093>0.05). There was no significant change in GERD symptoms before and after), LSG operation.

Conclusion

Due to the contradictory results of existing studies, the exact effect of LSG on the prevalence of GERD has not been answered. When choosing the appropriate weight loss technique, surgeons should carefully evaluate the preoperative symptoms of GERD in order to more clearly determine the effect of SG on GERD in patients with weight loss.

Key words: Laparoscopic sleeve gastrectomy, Gastroesophageal reflux disease, Meta analysis
图1 文献筛选流程
表1 纳入文献的基本特征
研究者名 年份 国家 例数 男/女 年龄 BMI
Howard[6] 2011 美国 28 10/18 42±8.0 55.5±10.25
Burgerhart[7] 2014 荷兰 20 4/16 43±12 47.6±6.1
Daes[8] 2014 哥伦比亚 382 120/262 38.2±14.0 37.7±8.5
Del Genio[9] 2014 美国 25 7/18 42±10.0 46.1±4.5
Gorodner[10] 2015 阿根廷 14 1/13 42±12 40±6
Coupaye[11] 2017 法国 47 1/46 41.1±9.4 43.3±5.7
Genco[12] 2017 意大利 110 - - 45.8±6.3
Georgia[13] 2017 希腊 12 3/9 36.7±6.44 48.97±7.17
花荣[14] 2017 中国 61 16/45 32±9.9 37.6±6.1
曹东亮[15] 2018 中国 113 21/92 30±8 36.5±7.3
Borbély[16] 2018 瑞士 222 103/119 43.1±12.8 49.6±7.2
表2 纳入研究的偏倚风险评价
纳入研究 随机方法 分配隐藏 盲法 结果数据的完整性（退出/失访） 选择性报告研究结果 其他偏倚来源
Howard 2011[6] 否 否 否 无 不清楚 不清楚
Burgerhart 2014[7] 否 否 否 有失访 不清楚 不清楚
Daes 2014[8] 否 否 否 有失访 不清楚 不清楚
Del Genio 2014[9] 否 否 否 有失访 不清楚 不清楚
Gorodner 2015[10] 否 否 否 有失访 不清楚 不清楚
Coupaye 2017[11] 否 否 否 有失访 不清楚 不清楚
Genco 2017[12] 否 否 否 有失访 不清楚 不清楚
Georgia 2017[13] 否 否 否 无 不清楚 不清楚
花荣 2017[14] 否 否 否 无 不清楚 不清楚
曹东亮 2018[15] 否 否 否 无 不清楚 不清楚
Borbély 2018[16] 否 否 否 有失访 不清楚 不清楚
图2 纳入研究的偏倚风险评价图
图3 LSG手术前后GERD症状的变化
图4 LSG手术后新出现的GERD症状
图5 LSG手术前后GERD-Q评分比较
图6 LSG手术前后24 h pH检测中DeMeester score比较
图7 LSG手术前后酸反流平均次数的比较
图8 LSG手术前后24 h pH检测中酸反流时间的比较
图9 LSG手术前后每日PPI摄入量的比较
图10 LSG手术后新出现的GERD症状比较的漏斗图
图11 LSG手术前后24-hr pH检测中酸反流时间比较的漏斗图
图12 LSG手术前后酸反流平均次数比较的漏斗图
1
González-Muniesa P, Mártinez-González M, Hu F B, et al. Obesity[J]. Nature Reviews Disease Primers, 2017, 3(1): 17034.
2
Mazzarella M. Erratum to: Abstracts from the 22nd World Congress of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO), London, 29 August–2 September 2017[J]. Obesity surgery, 2017, 27(10): 2779.
3
Yeung K T D, Penney N, Ashrafian L, et al. Does Sleeve Gastrectomy Expose the Distal Esophagus to Severe Reflux?: A Systematic Review and Meta-analysis[J]. Annals of Surgery, 2020, 271(2): 257-265.
4
Salminen P, Helmiö M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss at 5 years among patients with morbid obesity: the SLEEVEPASS randomized clinical trial[J]. Jama, 2018, 319(3): 241-254.
5
Snyder B, Wilson E, Wilson T, et al. A randomized trial comparing reflux symptoms in sleeve gastrectomy patients with or without hiatal hernia repair[J]. Surgery for Obesity and Related Diseases, 2016, 12(9): 1681-1688.
6
Howard D D, Caban A M, Cendan J C, et al. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients[J]. Surgery for Obesity and Related Diseases, 2011, 7(6): 709-713.
7
Burgerhart J S, Schotborgh C A, Schoon E J, et al. Effect of sleeve gastrectomy on gastroesophageal reflux[J]. Obesity surgery, 2014, 24(9): 1436-1441.
8
Daes J, Jimenez M E, Said N, et al. Improvement of gastroesophageal reflux symptoms after standardized laparoscopic sleeve gastrectomy[J]. Obesity surgery, 2014, 24(4): 536-540.
9
Del Genio G, Tolone S, Limongelli P, et al. Sleeve gastrectomy and development of "de novo" gastroesophageal reflux[J]. Obesity surgery, 2014, 24(1): 71-77.
10
Gorodner V, Buxhoeveden R, Clemente G, et al. Does laparoscopic sleeve gastrectomy have any influence on gastroesophageal reflux disease? Preliminary results[J]. Surgical endoscopy, 2015, 29(7): 1760-1768.
11
Coupaye M, Gorbatchef C, Calabrese D, et al. Gastroesophageal reflux after sleeve gastrectomy: a prospective mechanistic study[J]. Obesity surgery, 2018, 28(3): 838-845.
12
Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett's esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication[J]. Surgery for Obesity and Related Diseases, 2017, 13(4): 568-574.
13
Georgia D, Stamatina T, Maria N, et al. 24-h multichannel intraluminal impedance PH-metry 1 year after laparocopic sleeve gastrectomy: an objective assessment of gastroesophageal reflux disease[J]. Obesity surgery, 2017, 27(3): 749-753.
14
花荣, 陈浩, 丁锐, 等. 袖状胃切除手术前后的胃食管反流病[J]. 外科理论与实践, 2017, 22(6): 493-498.
15
曹东亮, 朱江帆, 马颖璋, 等. 腹腔镜胃袖状切除术对胃食管反流病的影响[J]. 腹腔镜外科杂志, 2018(2018年01): 17-20.
16
Borbély Y, Schaffner E, Zimmermann L, et al. De novo gastroesophageal reflux disease after sleeve gastrectomy: role of preoperative silent reflux[J]. Surgical endoscopy, 2019, 33(3): 789-793.
17
Richter J E, Rubenstein J H. Presentation and epidemiology of gastroesophageal reflux disease[J]. Gastroenterology, 2018, 154(2): 267-276.
18
Eusebi L H, Ratnakumaran R, Yuan Y, et al. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis[J]. Gut, 2018, 67(3): 430-440.
19
纪浩洋, 孟化. 腹腔镜袖状胃切除术对胃食管反流病的影响[J]. 腹腔镜外科杂志, 2019(2019年06): 474-477.
20
Raj P P, Bhattacharya S, Misra S, et al. Gastroesophageal reflux–related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study[J]. Surgery for Obesity and Related Diseases, 2019, 15(8): 1261-1269.
21
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(6): 458-461.
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