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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 ›› 2024, Vol. 11 ›› Issue (01) : 1 -5. doi: 10.3877/cma.j.issn.2095-8765.2024.01.001

论著

胃袖状切除术联合膈肌脚塑形术对术后胃食管反流的影响
詹崇文1, 汪洁1, 沈奇伟1, 花荣1, 姚琪远1,†()   
  1. 1. 200040　上海，复旦大学附属华山医院普外科
  • 收稿日期:2023-12-19 出版日期:2024-02-15
  • 通信作者: 姚琪远
  • 基金资助:
    国家自然科学基金青年项目(81800751)

Effect of sleeve gastrectomy combined with crura of diaphragm plasticity on gastroesophageal reflux disease after sleeve gastrectomy

Chongwen Zhan1, Jie Wang1, Qiwei Shen1, Rong Hua1, Qiyuan Yao1,†()   

  1. 1. Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2023-12-19 Published:2024-02-15
  • Corresponding author: Qiyuan Yao
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詹崇文, 汪洁, 沈奇伟, 花荣, 姚琪远. 胃袖状切除术联合膈肌脚塑形术对术后胃食管反流的影响[J]. 中华胃食管反流病电子杂志, 2024, 11(01): 1-5.

Chongwen Zhan, Jie Wang, Qiwei Shen, Rong Hua, Qiyuan Yao. Effect of sleeve gastrectomy combined with crura of diaphragm plasticity on gastroesophageal reflux disease after sleeve gastrectomy[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2024, 11(01): 1-5.

目的

评估腹腔镜胃袖状切除术（LSG）联合膈肌脚塑形术对LSG术后胃食管反流病（GERD）的影响。

方法

收集2022年6月至2023年3月复旦大学附属华山医院33例接受LSG或LSG联合膈肌脚塑形术的并按时完成随访的患者的临床资料，按手术方式分为2组。LSG组18例，LSG+膈肌脚塑形组15例。比较2组围手术期情况、术后减重效果及GERD情况。

结果

2组患者均成功实施腹腔镜手术，无增加戳孔或中转开腹的情况，未出现大出血、肠道损伤等术中并发症。LSG组平均手术时间为（97.06±23.28）min，术中出血量为（34.72±19.59）ml，术后住院时间为（3.44±0.78）d；LSG+膈肌脚塑形组平均手术时间为（100.33±14.82）min，术中出血量为（31.33±5.16）ml，术后住院时间为（3.47±0.74）d，2组差异均无统计学意义（P>0.05）。术后1个月，2组患者%EWL和%TWL比较，差异均无统计学意义（P>0.05）；LSG组GERD-Q评分为（6.89±1.53）分，LSG+膈肌脚塑形组为（6.80±1.37）分，2组差异均无统计学意义（P>0.05）；LSG组GERD-Q评分≥8分的患者共5例（27.78%），LSG+膈肌脚塑形组中有4例（26.67%），2组差异均无统计学意义（P>0.05）。术后6个月，2组患者%EWL和%TWL比较，差异均无统计学意义（P>0.05）；LSG组患者GERD-Q评分为（6.06±0.24）分，LSG+膈肌脚塑形组为（6.40±1.12）分，2组差异均无统计学意义（P>0.05）；LSG组GERD-Q评分≥8分的患者共0例（0.00%），LSG+膈肌脚塑形组2例（13.33%），2组差异均无统计学意义（P>0.05）。

结论

LSG联合膈肌脚塑形相较于LSG并不会延长手术时间、增加手术并发症以及影响术后康复，且对LSG术后GERD情况无显著影响。

关键词: 肥胖症, 胃袖状切除术, 膈肌脚塑形术, 胃食管反流病
Objective

To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) combined with crura of diaphragm plasticity on gastroesophageal reflux disease (GERD) after LSG.

Methods

Clinical data of 33 patients with obesity who underwent LSG or LSG combined with crura of diaphragm plasticity from June 2022 to March 2023 and completed follow-up in time were retrospectively analyzed. Group as surgical method, there were 18 cases in LSG group and 15 cases in LSG combined with crura of diaphragm plasticity group. Perioperative indicators, improvement of obesity and severity of GERD were compared in these two groups.

Results

All procedures were performed via laparoscopic surgery. In LSG group, mean operative time was (97.06±23.28) min, volume of intraoperative blood loss was (34.72±19.59) ml, hospital stay after operation was (3.44±0.78) d. In LSG combined with crura of diaphragm plasticity group, mean operative time was (100.33±14.82) min, volume of intraoperative blood loss was (31.33±5.16) ml, hospital stay after operation was (3.47±0.74) d, with no statistical significance between the two groups (P>0.05). One month after surgery, there was no significant difference in %EWL and %TWL between the two groups (P>0.05). The GERD-Q score of LSG group was (6.89±1.53) points, and that of LSG combined with crura of diaphragm plasticity group was (6.80±1.37) points, with no statistical significance between the two groups (P>0.05). There were 5 patients (27.78%) with GERD-Q score ≥8 points in LSG group, and 4 patients (26.67%) in LSG combined with crura of diaphragm plasticity group, with no statistical significance between the two groups (P>0.05). Six months after surgery, there was no significant difference in %EWL and %TWL between the two groups (P>0.05). The GERD-Q score of LSG group was (6.06±0.24) points, and that of LSG combined with crura of diaphragm plasticity group was (6.40±1.12) points, with no statistical significance between the two groups (P>0.05). There were 0 patients (0.00%) with GERD-Q score ≥8 points in LSG group, and 2 patients (13.33%) in LSG combined with crura of diaphragm plasticity group, with no statistical significance between the two groups (P>0.05).

Conclusion

Compared with LSG, LSG combined with crura of diaphragm plasticity did not prolong operation time, increase surgical complications and affect postoperative rehabilitation, and had no significant effect on GERD after LSG.

Key words: Obesity, Sleeve gastrectomy, Crura of diaphragm plasticity, Gastroesophageal reflux disease
表1 2组患者一般资料比较
组别 例数 年龄（岁，） 性别（男性/女性） BMI（kg/m2，） GERD-Q评分（分，）
LSG组 18 33.06±10.30 4/14 38.49±6.07 6.06±0.24
LSG+膈肌脚塑形组 15 29.33±6.57 4/11 40.29±5.89 6.00±0.00
检验值 1.208 0.088 0.140 0.910
P值 0.236 0.767 0.889 0.370
表2 2组手术相关情况及术后住院时间比较（）
组别 例数 手术时间（min） 术中出血量（ml） 术后住院时间（d）
LSG组 18 97.06±23.28 34.72±19.59 3.44±0.78
LSG+膈肌脚塑形组 15 100.33±14.82 31.33±5.16 3.47±0.74
t值 -0.471 0.650 -0.083
P值 0.641 0.521 0.934
表3 2组术后1个月随访情况比较
组别 例数 %EWL（%，） %TWL（%，） GERD-Q评分（分，） GERD-Q≥8分[例（%）]
LSG组 18 30.14±7.78 10.66±1.70 6.89±1.53 5（27.78）
LSG+膈肌脚塑形组 15 33.40±13.44 10.89±3.55 6.80±1.37 4（26.67）
检验值 -0.872 -0.243 -0.174 0.005
P值 0.390 0.810 0.863 0.943
表4 2组术后6个月随访情况比较
组别 例数 %EWL（%，） %TWL（） GERD-Q评分（分，） GERD-Q≥8分[例（%）]
LSG组 18 71.43±18.30 25.65±5.10 6.06±0.24 0（0.00）
LSG+膈肌脚塑形组 15 87.25±28.89 28.94±5.38 6.40±1.12 2（13.33）
检验值 -10.911 -1.795 -1.274 2.555
P值 0.065 0.082 0.212 0.110
1
Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) indications for metabolic and bariatric surgery[J]. Obes Surg, 2023, 33(1): 3-14.
2
Clapp B, Ponce J, Demaria E, et al. American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States[J]. Surg Obes Relat Dis, 2022, 18(9): 1134-1140.
3
中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2022年度报告[J]. 中华肥胖与代谢病电子杂志,2023, 9(2):83-91.
4
Salminen P, Grönroos S, Helmiö M, et al. Effect of laparoscopic sleeve gastrectomy vs roux-en-y gastric bypass on weight loss, comorbidities, and reflux at 10 years in adult patients with obesity: the SLEEVEPASS randomized clinical trial[J]. JAMA Surg, 2022, 157(8): 656-666.
5
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]. Ann Surg, 2020, 271(2): 257-265.
6
Bou Daher H, Sharara AI. Gastroesophageal reflux disease, obesity and laparoscopic sleeve gastrectomy: the burning questions[J]. World J Gastroenterol, 2019, 25(33): 4805-481
7
Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease[J]. BMJ, 2020, 371: m3786.
8
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(4): 328-334.
9
Khaitan L, Hill M, Michel M, et al. Feasibility and efficacy of magnetic sphincter augmentation for the management of gastroesophageal reflux disease post-sleeve gastrectomy for obesity[J]. Obes Surg, 2023, 33(1): 387-396.
10
Di Capua F, Cesana GC, Uccelli M, et al. Sleeve gastrectomy with rossetti fundoplication increases lower esophageal sphincter tone preventing gastroesophageal reflux disease: high-resolution manometry assessment[J]. J Laparoendosc Adv Surg Tech A, 2023, 33(1): 44-51.
11
Felinska E, Billeter A, Nickel F, et al. Do we understand the pathophysiology of GERD after sleeve gastrectomy?[J]. Ann N Y Acad Sci, 2020, 1482(1): 26-35.
12
Guzman-Pruneda FA, Brethauer SA. Gastroesophageal reflux after sleeve gastrectomy[J]. J Gastrointest Surg, 2021, 25(2): 542-550.
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