腹腔镜袖状胃切除术中胃窦切缘与幽门的距离对术后胃食管反流病及减重效果的影响  

Effect of different antrum margin to pylorus distance on postoperative gastroesophageal reflux disease and weight loss in laparoscopic sleeve gastrectomy

作　　者：伍振鹏 乔钰涵 向林 江云颂 彭居正 吴丽娜[1] 程吕佳 关炳生 庄子康 杨景哥[1] 王存川 Wu Zhenpeng;Qiao Yuhan;Xiang Lin;Jiang Yunsong;Peng Junzheng;Wu Lina;Cheng Lvjia;Guan Bingsheng;Zhuang Zikang;Yang Jingge(Department of Gastrointestinal Surgery,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China)

机构地区：[1]暨南大学附属第一医院胃肠外科一区,广州510630 [2]不详

出　　处：《中华肥胖与代谢病电子杂志》2023年第1期4-11,共8页Chinese Journal Of Obesity and Metabolic Diseases：Electronic Edition

基　　金：广州市科技计划项目资助(202201020064);广东省自然科学基金(2017A030313855)。

摘　　要：目的探讨腹腔镜袖状胃切除术(LSG)中不同胃窦切缘与幽门的距离对术后胃食管反流病(GERD)和减重效果之间的关系。方法采取单中心前瞻性随机对照研究,纳入2018年3月至2019年3月在暨南大学附属第一医院接受LSG的肥胖症患者45例,并将其随机平均分为3组,分别为G1组:胃窦切缘距幽门2 cm;G2组:胃窦切缘距幽门4 cm;G3组:胃窦切缘距幽门6 cm。在LSG术前以及术后的1月、3月、6月和1年采集相关数据,包括体重、BMI、多余体重减少百分比(%EWL)、总体重减轻百分比(%TWL)、胃食管反流病健康相关生活质量问卷(GERD-HRQL)评分等,并进行分析。结果各组间术后1月、3月、6月及1年体重、BMI下降和%TWL变化差异均有统计学意义(P<0.05)。在GERD-HRQL评分中,与术前相比,各组间术后1月的总分及胃灼热分数均明显升高(P<0.05)。术前2例伴有GERD的患者术后症状均有所改善。术后1年随访中发现了6例新发的GERD,分别为:G1组1例,G2组3例和G3组2例,各组间GERD的发生差异无统计学意义。单因素分析结果提示手术方案与术后体重变化明显相关:G1组术后平均BMI下降和术后平均%TWL的变化较G2和G3两组明显,差异有统计学意义(P<0.05)。结论LSG术后患者GERD-HRQL评分总体呈上升趋势,但不同的胃窦切缘距离与术后GERD的发生无显著相关性。相比于4 cm和6 cm,胃窦切缘距幽门2 cm可能是LSG术后获得更好减重效果的安全距离。Objective To investigate the effect of the distance between gastric antrum margin and pylorus in laparoscopic sleeve gastrectomy(LSG)on postoperative gastroesophageal reflux disease(GERD)and weight loss.Methods A single-center prospective randomized controlled study was used.45 patients who received LSG during March 2018 to March 2019 were included.Patients were equally divided into 3 groups according to the distance between antral margin and pylorus by computerized random grouping method:G1(2 cm),G2(4 cm),and G3(6 cm).Data were collected and analyzed before and 1 month,3 months,6 months and 1 year after LSG.Results There were statistically significant differences in the postoperative BMI decrease and%TWL between the groups(P<0.05).The postoperative symptoms of 2 patients with GERD before surgery were improved.There have 6 patients were new-onset of the GERD after 1 year of follow-up.In the GERD-HRQL score,the total score and heartburn score at 1 month after surgery were significantly higher among all groups compared with those before surgery(P<0.05).Compared with G2 and G3 groups,the average postoperative BMI decreased and the average%TWL increased more significantly in G1 group,with statistically significant differences(P<0.05).Conclusions This study found that postoperative GERD-HRQL scores have generally increase.Yet,there was no significant correlation between different antral margin distances and the occurrence of postoperative GERD.Compared with 4 cm and 6 cm,2 cm between antral margin and pylorus may be a safe distance to achieve better weight loss after LSG.

关 键 词：腹腔镜袖状胃切除术 胃窦切缘距离 胃食管反流病 肥胖症 减重手术 

分 类 号：R73[医药卫生—肿瘤]