袖状胃切除联合胃底折叠治疗肥胖症合并胃食管反流病的减重代谢及抗反流效果分析  

Analysis of weight loss,metabolism,and anti-reflux effect of sleeve gastrectomy combined with fundoplication as treatment of obesity complicated by gastroesophageal reflux disease

作　　者：黎鑫 艾克拜尔·艾力[2,3,4] 阿丽叶古丽·艾皮热 皮尔地瓦斯·麦麦提玉素甫[2] 麦麦提艾力·麦麦提明 王浩[1,2] 玉素江·图荪托合提 阿迪力·买买提 克力木·阿不都热依木[2,3,4] Li Xin;Aikebaier·Aili;Aliyeguli·Aipire;Pierdiwasi·Maimaitiyusupu;Maimaitiaili·Maimaitiming;Wang Hao;Yusujiang·Tusuntuoheti;Adili·Maimaiti;Kelimu·Abudureyimu(Graduate School,Xinjiang Medical University,Urumqi 830054,China;Department of Minimally Invasive,Hernia and Abdominal Surgery,People's Hospital of Xinjiang Autonomous Region,Urumqi 830011,China;Institute of General Surgery and Minimally Invasive Surgery,Xinjiang Uygur Autonomous Region,Urumqi 830011,China;Clinical Research Center for Gastroesophageal Reflux Disease and Weight Loss and Metabolic Surgery,Xinjiang Uygur Autonomous Region,Urumqi 830011,China)

机构地区：[1]新疆医科大学研究生院,乌鲁木齐830054 [2]新疆维吾尔自治区人民医院微创、疝与腹壁外科,乌鲁木齐830011 [3]新疆维吾尔自治区人民医院普外微创研究所,乌鲁木齐830011 [4]新疆维吾尔自治区胃食管反流病及减重代谢外科临床研究中心,乌鲁木齐830011

出　　处：《中华胃肠外科杂志》2024年第5期478-485,共8页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(82060166);新疆维吾尔自治区人民医院院内项目(20230131);新疆维吾尔自治区研究生创新项目(XJ2023G201)。

摘　　要：目的探究腹腔镜袖状胃切除联合胃底折叠(SGFD)治疗肥胖症合并胃食管反流病(GERD)的减重代谢及抗反流效果,从而为该类患者提供最佳的治疗方案。方法本研究采用回顾性队列研究方法。收集新疆维吾尔自治区人民医院微创、疝与腹壁外科于2019年1月至2023年2月收治的140例肥胖症(体质指数≥30 kg/m^(2))合并GERD(经术前GerdQ评分、胃镜、上消化道造影、食管24 h pH监测及高分辨食管测压确诊)行减重手术治疗患者的临床资料。根据手术方式将研究对象分为袖状胃切除术组(SG组,92例)和SGFD组(48例)。SGFD是本团队首创的新型抗反流减重手术方式,通过“先切除,再折叠”的方法同时发挥抗反流和减重作用。主要比较分析SG组与SGFD组手术情况,以及术后3和6个月的减重、改善代谢及抗反流效果。结果140例患者中男性50例,女性90例;年龄(36.0±9.6)岁;术前体质指数为(38.5±6.5)kg/m^(2);术前GerdQ评分为(10.2±1.6)分。SGFD组与SG组患者的一般临床资料比较差异均无统计学意义(均P>0.05)。两组患者术后住院时间、术中出血量和术后并发症发生情况比较,差异均无统计学意义(均P>0.05);但SGFD组的手术时间长于SG组[(137.5±10.5)min比(105.3±12.6)min,t=‒15.131,P<0.001]。与术前比较,SGFD组患者术后3个月空腹血糖、胆固醇、体质量、体质指数、GerdQ评分均更低(均P<0.05);而在术后6个月时,除了前述指标较术前更低外,甘油三酯、尿酸、DeMeester评分也均更低,但食管下括约肌静息压(LESP)升高(均P<0.05)。与SG组比较,SGFD组患者术后第3个月、第6个月减重指标(体质量、体质指数、多余体质量减少百分比)和代谢指标(空腹血糖、甘油三酯、胆固醇、尿酸水平)差异均无统计学意义(均P>0.05),但术后第6个月抗反流指标(GerdQ评分、DeMeester评分和LESP)优于SG术后患者,差异具有统计学意义(均P<0.05)。结论肥胖合并GERD患者在SGObjective To explore the weight-loss,metabolism,and anti-reflux effect of laparoscopic sleeve gastrectomy combined with fundoplication(SGFD)as treatment of obesity complicated by gastroesophageal reflux disease(GERD)with the aim of identifying the best treatment for such patients.Methods This was a retrospective cohort study.Relevant clinical data of 140 patients with obesity(body mass index≥30 kg/m^(2))complicated by GERD(confirmed by preoperative GerdQ score,gastroscope,upper gastrointestinal radiography,24-hour pH monitoring of esophagus,and high-resolution esophageal manometry)who had undergone bariatric surgery in the Minimally Invasive Surgery,Hernia and Abdominal Surgery Department of the People's Hospital of Xinjiang Uygur Autonomous Region from January 2019 to February 2023 were collected.The participants were allocated to the following groups according to surgical procedure performed:sleeve gastrectomy group(SG group,92 cases)versus SGFD(SGFD group,48 cases).SGFD,a new type of anti-reflux weight loss surgery that achieves both anti-reflux and weight loss effects by a procedure involving"cutting first and then folding",was developed by our team.In this study,our main aim was to compare and analyze differences in outcomes between the SG and SGFD groups in terms of weight loss and improvements in metabolism and reflux 3 and 6 months postoperatively.Results The 140 patients comprised 50 men and 90 women of average age 36.0±9.6 years and preoperative body mass index(BMI)(38.5±6.5)kg/m^(2).The average preoperative GERD score was 10.2±1.6.There were no significant differences in baseline characteristics between the SGFD and SG groups(all P>0.05).There were also no significant differences in postoperative hospital stay,intraoperative blood loss,or postoperative complications between the two groups(all P>0.05).However,the operation time was longer in the SGFD than SG group(137.5±10.5 minutes vs.105.3±12.6 minutes,t=-15.131,P<0.001).Compared with preoperative values,fasting blood glucose,cholesterol,body m

关 键 词：肥胖症 胃食管反流病 袖状胃切除 胃底折叠 减重 代谢 抗反流 

分 类 号：R656.6[医药卫生—外科学]