摘要
目的探讨袖状胃切除同期行食管裂孔疝修补手术在减重和抗反流中的应用价值。方法本研究纳入2019年12月至2020年12月在浙江省人民医院减重代谢中心接受腹腔镜袖状胃切除术的合并胃食管反流病的21例肥胖患者,根据患者是否同期行食管裂孔疝修补分为单纯减重手术组(9例)和同期联合手术组(12例)。结果两组患者术后体重、腰围、BMI指标均呈下降趋势,与术前比较差异均有统计学意义(F=5.154 P=0.013;F=14.319,P<0.001;F=6.725,P=0.004),术后6个月与术后1个月两组患者多余体重减除率比较差异均有统计学意义(t=8.927,P<0.001;t=8.926,P<0.001)。单纯减重手术组患者术后食管下括约肌静息压、胃食管反流症状评分与术前相比差异均无统计学意义(t=-0.891,P=0.507;t=0.629,P=0.298)。同期联合手术组患者术后胃食管反流症状评分较术前明显减低,食管下括约肌静息压较术前明显升高,差异均有统计学意义(t=-10.539,P<0.001;t=5.066,P=0.038)。同期联合手术组术后发生1例胃漏。结论肥胖合并胃食管反流的患者行联合手术与单纯减重手术均有较好的减重效果,但前者的抗反流效果更明显。
Objective To evaluate the laparoscopic sleeve gastrectomy combined with hiatal hernia repair surgery for weight loss and antireflux.Methods This study included 21 obese patients with gastroesophageal reflux who underwent laparoscopic sleeve gastrectomy at the Weight Loss Metabolism Center of the Department of Hepatobiliary and Pancreatic Surgery of Zhejiang Provincial People's Hospital from Dec 2019 to Dec 2020.Patients were divided into simple bariatric surgery group(9 cases)and simultaneous combined surgery group(12 cases).Results In the combined surgery group,1 case had postoperative gastric leakage.The postoperative body weight,waist circumference,and BMI indexes of the two groups showed a downward trend(F=5.154,P=0.013;F=14.319,P<0.001;F=6.725,P=0.004).There was a statistically significant difference in the excess weight loss in both the two groups at 6 months after the operation compared to 1 month after the operation(t=8.927,P<0.001;t=8.926,P<0.001).There was no statistically significant difference in postoperative lower esophageal sphincter resting pressure and Gerd symptom score in the bariatric surgery group compared with preoperative(t=-0.891,P=0.507;t=0.629,P=0.298).The postoperative Gerd symptom score of the patients in the combined surgery group was significantly lower than that before the operation,and the resting pressure of the lower esophageal sphincter was significantly higher than that before the operation,(t=-10.539,P<0.001;t=5.066,P=0.038).Conclusion Combined surgery have the same weight loss effect as in simple bariatric surgery in obese patients with gastroesophageal reflux,in addition to stronger anti-reflux effect.
作者
张松泽
夏建福
陈浩
毛金磊
刘军伟
何信众
吴瑶娟
王知非
Zhang Songze;Xia Jianfu;Chen Hao;Mao Jinlei;Liu Junwei;He Xinzhong;Wu Yaojuan;Wang Zhifei(Department of General Surgery,the Affiliated People's Hospital of Ningbo University,Ningbo 315000,China;Department of General Surgery,Wenzhou Central Hospital,Wenzhou 325000,China;Hepatobiliary Pancreatic and Minimally Invasive Surgery,Zhejiang Provincial People's Hospital,Hangzhou 310014,China;Hepatobiliary Pancreatic Surgery,Tongxiang First People's Hospital,Tongxiang 314500,China)
出处
《中华普通外科杂志》
CSCD
北大核心
2022年第2期94-98,共5页
Chinese Journal of General Surgery
基金
国家科学技术部重点研发计划子课题(2018YFB1107104)
新疆维吾尔自治区区域协同创新专项(2019E0287)
浙江省基础公益研究项目(LGF18H030004)
浙江省卫生健康科技计划项目(2021ky486)。
