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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2024, Vol. 17 ›› Issue (02) : 95 -99. doi: 10.3877/cma.j.issn.1674-6899.2024.02.006

论著

LSG中保留胃窦部及His角完整性对术后胃食管反流病的影响
孙武青1, 郭震1, 郝少龙1, 孙海涛1, 姬阆2, 白日星1, 韩威1,†()   
  1. 1. 101149　北京，首都医科大学附属北京潞河医院普外科
    2. 101149　北京，首都医科大学附属北京潞河医院中心实验室
  • 收稿日期:2024-02-26 出版日期:2024-04-30
  • 通信作者: 韩威
  • 基金资助:
    北京市通州区科技计划项目(KJ2024CX039)

The effect of preserving the integrity of the gastric antrum and His angle during laparoscopic gastric sleeve resection on postoperative gastroesophageal reflux disease

Wuqing Sun1, Zhen Guo1, Shaolong Hao1, Haitao Sun1, lang Ji2, Rixing Bai1, Wei Han1,†()   

  1. 1. Department of General Surgery, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
    2. Central Laboratory, Beijing Luhe Clinical Institute, Capital Medical University, Beijing 101149, China
  • Received:2024-02-26 Published:2024-04-30
  • Corresponding author: Wei Han
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孙武青, 郭震, 郝少龙, 孙海涛, 姬阆, 白日星, 韩威. LSG中保留胃窦部及His角完整性对术后胃食管反流病的影响[J]. 中华腔镜外科杂志(电子版), 2024, 17(02): 95-99.

Wuqing Sun, Zhen Guo, Shaolong Hao, Haitao Sun, lang Ji, Rixing Bai, Wei Han. The effect of preserving the integrity of the gastric antrum and His angle during laparoscopic gastric sleeve resection on postoperative gastroesophageal reflux disease[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(02): 95-99.

目的

探讨腹腔镜胃袖状切除术中保留胃窦部及His角完整性对术后胃食管反流病的影响。

方法

回顾性分析首都医科大学附属北京潞河医院2022年1月至2023年8月行腹腔镜胃袖状切除手术的肥胖症患者76例，并完成术后6个月随访的患者。分为A组40例(保留胃窦部及His角周围组织完整性)和B组36例(未保留胃窦结构及His角周围组织的完整性)。对比分析两组患者术后1、3、6个月体质量指数(body mass index，BMI)、多余体质量下降百分比(percent excess weight loss，%EWL)及胃食管反流病问卷(gastroesophageal reflux disease questionnaire, Gerd-Q)量表评分的差异性。

结果

A、B两组患者术前及术后6个月BMI差异无统计学意义(39.44±6.032 kg/m2 vs. 41.74±6.677 kg/m2; 28.99±4.763 kg/m2 vs. 29.82±4.651 kg/m2, P>0.05)。A、B两组患者术前胃食管反流病(gastroesophageal reflux disease, GERD)的发病率分别是27.5%(11例)、27.8%(10例)，无明显差异(P>0.05)。术后1、3、6个月时A组患者GERD的发病率(Gerd-Q评分≥8)分别是30.0%(12例)、27.5%(11例)、22.5%(9例)，显著低于B组的41.7%(15例)、38.9%(14例)、36.1%(13例)，P<0.05。

结论

保留胃窦部及His角的完整性并不影响减重效果，并且有利于降低胃袖状切除术后GERD的发病率。

关键词: 腹腔镜胃袖状切除术, 胃窦部, His角, 胃食管反流病问卷(Gerd-Q)
Objective

Exploring the effect of preserving the integrity of the gastric antrum and His angle during laparoscopic gastric sleeve resection on postoperative gastroesophageal reflux disease.

Methods

Retrospective analysis of 76 obese patients who underwent laparoscopic gastric sleeve resection surgery at Beijing Luhe Hospital affiliated with Capital Medical University from Jan. 2022 to Aug. 2023, and patients who completed 6 months of postoperative follow-up. Divided into Group A with 40 cases (preserving the integrity of gastric antrum and His angle surrounding tissues) and Group B with 36 cases (not preserving the integrity of gastric antrum structure and His angle surrounding tissues). Compare and analyze the differences in body mass index (BMI), percentage excess weight loss (EWL) and GERD-Q (Gastroesophageal Reflux Disease Questionnaire) scores between two groups of patients at 1, 3, and 6 months after surgery.

Results

There was no significant difference in BMI between the two groups of patients before and 6 months after surgery (39.44 ± 6.032 kg/m2 vs. 41.74±6.677 kg/m2; 28.99±4.763 kg/m2 vs. 29.82±4.651 kg/m2, P>0.05). A. The incidence rate of GERD disease before operation was 27.5% (11 cases) and 27.8% (10 cases) respectively in group B, with no significant difference (P>0.05). The incidence rate of GERD disease (Gerd-Q score ≥ 8) in group A was 30.0% (12 cases), 27.5% (11 cases), 22.5% (9 cases) respectively at 1, 3, and 6 months after surgery, which was significantly lower than 41.7%(15 cases), 38.9% (14 cases), and 36.1% (13 cases) in group B, P<0.05.

Conclusion

Preserving the integrity of gastric antrum and His angle does not affect the weight loss effect, and is conducive to reducing the incidence rate of GERD after gastric sleeve resection.

Key words: Laparoscopic sleeve gastrectomy, Gastric antrum, His angle, Gerd-Q
图1 保留胃窦部及His角完整性的腹腔镜胃袖状切除术注：A．切割起点距幽门管距离5～6 cm；B：保留His角周围组织；C：距His角约1.5 cm离断胃底部
表1 两组患者一般资料、术前胃镜及手术时间比较
临床资料 A组(n＝40) B组(n＝36) χ2(t)值 P值
性别(男/女，例) 17/23 16/20 0.029 0.864
年龄(岁) 33.95±9.819 33.31±9.570 0.289 0.773
手术时间(min) 121.90±31.512 119.47±39.742 0.182 0.768
胃镜-反流性食管炎 14/40(35.0%) 13/36(36.1%) 0.010 0.920
表2 两组患者术前及术后1、3、6个月BMI比较
  A组(n＝40) B组(n＝36) t值 P值
术前 39.44±6.032 41.74±6.677 －1.577 0.168
术后1个月 34.93±5.241 36.26±6.006 －1.027 0.308
术后3个月 31.74±5.291 32.36±5.049 －0.520 0.605
术后6个月 28.99±4.763 29.82±4.651 －0.773 0.442
表3 两组患者术后1、3、6个月%EWL比较
  A组(n＝40) B组(n＝36) t值 P值
术后1个月 27.57±7.886 31.03±11.138 －1.577 0.119
术后3个月 48.27±16.701 51.79±14.159 －0.980 0.331
术后6个月 64.98±19.827 65.84±17.230 －0.199 0.843
表4 A、B两组患者术前、术后1、3、6个月Gerd-Q量表评分比较
  A组(n＝40) B组(n＝36) t值 P值
术前 6.83±2.659 7.67±2.461 0.156 0.139
术后1个月 6.80±3.220 9.00±3.660 0.006 0.011
术后3个月 5.60±3.209 7.58±3.426 0.012 0.009
术后6个月 4.90±2.994 6.86±3.697 0.014 0.018
表5 A、B两组患者术前、术后GERD发病率比较
分组 n 术前[n(%)] 术后1个月[n(%)] 术后3个月[n(%)] 术后6个月[n(%)] χ2值 P值
A组 40 11(27.5) 12(30.0) 11(27.5) 9(22.5) 6.333 0.188
B组 36 10(27.8)a 15(41.7)b 14(38.9)b 13(36.1)b 8.400 0.038
1
Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014[J]. Obes Surg, 2017, 27(9)：2279-2289.
2
花荣，陈浩，丁锐，等. 袖状胃切除手术前后的胃食管反流病[J]. 外科理论与实践，2017, 22(6)：493-498.
3
Silveira FC, Poa-Li C, Pergamo M, et al. The effect of laparoscopic sleeve gastrectomy on gastroesophageal reflux disease[J]. Obes Surg, 2021, 31(3)：1139-1146.
4
Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus[J]. Am J Gastroenterol, 2006, 101(8)：1900-1920; quiz 1943.
5
Jones R, Junghard O, Dent J, et al. Development of the GerdQ, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care[J]. Aliment Pharmacol Ther, 2009, 30(10)：1030-1038.
6
Abdallah E, El Nakeeb A, Youssef T, et al. Impact of extent of antral resection on surgical outcomes of sleeve gastrectomy for morbid obesity (a prospective randomized study)[J]. Obes Surg, 2014, 24(10)：1587-1594.
7
El Nakeeb A, Aldossary H, Zaid A, et al. Prevalence, predictors, and management of gastroesophageal reflux disease after laparoscopic sleeve gastrectomy: a multicenter cohort study[J]. Obes Surg, 2022, 32(11)：3541-3550.
8
Chiu S, Birch DW, Shi X, et al. Effect of sleeve gastrectomy on gastroesophageal reflux disease: a systematic review[J]. Surg Obes Relat Dis, 2011, 7(4)：510-515.
9
Sharara AI, Rustom LBO, Bou Daher H, et al. Prevalence of gastroesophageal reflux and risk factors for erosive esophagitis in obese patients considered for bariatric surgery[J]. Dig Liver Dis, 2019, 51(10)：1375-1379.
10
Sancho Moya C, Bruna Esteban M, Sempere García-Argüelles J, et al. The impact of sleeve gastrectomy on gastroesophageal reflux disease in patients with morbid obesity[J]. Obes Surg, 2022, 32(3)：615-624.
11
Daes J, Jimenez ME, Said N, et al. Improvement of gastroesophageal reflux symptoms after standardized laparoscopic sleeve gastrectomy[J]. Obes Surg, 2014, 24(4)：536-540.
12
Daes J, Jimenez ME, Said N, et al. Laparoscopic sleeve gastrectomy: symptoms of gastroesophageal reflux can be reduced by changes in surgical technique[J]. Obes Surg, 2012, 22(12)：1874-1879.
13
闫文貌，孙海涛，白日星. 胃袖状切除相关术式中应重视胃窦部解剖与生理功能[J/CD]. 中华肥胖与代谢病电子杂志，2023, 9 (3)：161-164.
14
胡三元. 机器人辅助袖状胃切除术操作指南(2020年版)[J]. 腹腔镜外科杂志，2021, 26(1)：1-6.
15
Avlanmis O, Isil RG, Burcu B. Effect of resection distance from pylorus on weight loss outcomes in laparoscopic sleeve gastrectomy[J]. Obes Surg, 2019, 29(9)：2731-2738.
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