单纯Roux-en-Y胃旁路术治疗超重或肥胖合并食管裂孔疝4例报告

Report of 4 cases of overweight or obesity patients combined with hiatal hernia treated with Roux-en-Y gastric bypass alone

目的:探讨腹腔镜Roux-en-Y胃旁路术对超重或肥胖合并食管裂孔疝患者的治疗效果。方法:回顾分析2012年11月至2019年12月为4例肥胖或超重合并食管裂孔疝患者行减重及代谢手术的临床资料及随访资料。结果:4例患者中2例超重合并2型糖尿病,2例肥胖合并糖尿病或糖耐量异常,均合并高血压及血脂异常。3例术前胃镜提示食管裂孔疝,其中2例合并反流性食管炎(洛杉矶分级B级),诊断为胃食管反流病。4例术中均探查明确食管裂孔疝。4例患者均行单纯Roux-en-Y胃旁路术,未对食管裂孔疝进行修补。术后随访2~11.5年。肥胖患者术后1年内体重下降明显,多余体重减少百分比分别为63.64%与70.59%。2例超重合并糖尿病患者分别于术后第6个月、5年时血糖升高,另1例肥胖伴糖尿病患者完全缓解。4例患者术后均未出现胃食管反流症状;1例轻度贫血;高血压均缓解,肝功、血脂未见异常。结论:单纯Roux-en-Y胃旁路术治疗肥胖合并食管裂孔疝患者可有效减轻体重,对于超重或肥胖伴随疾病有明显改善,是安全、有效的。

Objective:To explore the therapeutic efficacy of laparoscopic Roux-en-Y gastric bypass on patients with overweight or obesity who combined with hiatal hernia.Methods:This retrospective study analyzed the clinical and follow-up data of 4 patients with obesity or overweight combined with hiatal hernia who underwent bariatric surgery from Nov.2012 to Dec.2019.Results:A total of four patients were included:two overweight with type 2 diabetes and two obesity with diabetes or glucose intolerance.All four patients presented with hypertension and dyslipidemia.Preoperative gastroscopy suggested hiatal hernia in three cases,two of which exhibited a combination of reflux esophagitis(grade La-B)and a diagnosis of gastroesophageal reflux disease.Intraoperative exploration confirmed a h iatal hernia in all the patients.Roux-en-Y gastric bypass was performed in four patients.The hiatal hernia were not repaired.The postoperative follow-up period ranged from 2 to 11.5 years.Obese patients experienced significant weight loss within 1 year after surgery,with percentage of excess weight loss of 63.64%and 70.59%,respectively.Two overweight patients with diabetes exhibited elevated blood glucose levels at 6 months and 5 years after surgery,whereas the other patient with obesity and diabetes had complete remission.Four patients did not experience gastroesophageal reflux symptoms postoperatively.One patient developed mild anemia postoperatively,and hypertension was alleviated in all patients,with no abnormalities in liver function and blood lipids.Conclusions:Roux-en-Y gastric bypass demonstrates efficacy in reducing weight among patients with obesity concomitant with hiatal hernia,and exhibits significant i mprovement in comorbidities associated with overweight or obesity.The absence of gastroesophageal reflux symptoms during the post-operative follow-up period preliminarily indicates the safety and effectiveness of this procedure in overweight or obese patients with h iatal hernia.