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  

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

作　　者：艾克拜尔·艾力[1,2] 皮尔地瓦斯·麦麦提玉素甫 阿巴伯克力·乌斯曼[1] 买买提·依斯热依力 赛甫丁·艾比布拉 李义亮[1,2] 伊比提哈尔·买买提艾力[1] 蒋媛赛米·赛麦提 克力木·阿不都热依木 Aikebaier·Aili;Pierdiwasi·Maimaitiyusufu;Ababokeli·Wusiman;Maimaiti·Yisireyili;Saifuding·Aibibula;Liyiliang;Yibitihaer·Maimaitiaili;Jiangyuan;Saimi·Saimaiti;Kelimu·Abudureyimu(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)

机构地区：[1]新疆维吾尔自治区人民医院微创,疝和腹壁外科,乌鲁木齐830001 [2]新疆维吾尔自治区普外微创研究所,乌鲁木齐830001

出　　处：《中华胃食管反流病电子杂志》2020年第1期41-45,共5页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

基　　金：新疆维吾尔自治区引进高层次人才天池百人计划项目(201939)。

摘　　要：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。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.

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 

分 类 号：R655.4[医药卫生—外科学] R656.61[医药卫生—临床医学]