腹腔镜胃底联合大弯侧折叠治疗肥胖症伴胃食管反流疗效分析

Laparoscopic Nissen fundoplication with gastric plication as a potential treatment of morbidly obese patients with GERD

目的观察腹腔镜胃底折叠联合大弯侧折叠治疗肥胖症的疗效。方法回顾性分析2012年3月至2013年7月复旦大学附属华山医院收治的6例肥胖症伴胃食管反流病人的临床资料,均行腹腔镜胃底折叠联合大弯侧折叠治疗。结果全组病例均顺利在腹腔镜下完成手术,无中转开腹。平均手术时间为145（118~170）min,术后平均住院时间为3.8（3~5）d。术后1例病人围手术期出现缝合处胃壁穿孔,经缝合修补后痊愈出院,但术后失访,其余5例病人获得随访。术后第1、3、6、12个月多余体重减少百分比（%EWL）分别为26.8%、49.1%、64.3%、64%,术后1年平均体重指数（BMI）为25.7（22.7~28.7）,术后1年体重减轻平均17.8 kg。5例病人均伴有糖尿病,术后空腹血糖及糖化血红蛋白均控制良好,3例完全缓解,2例部分缓解;合并高脂血症和高尿酸血症病人术后均完全缓解。5例病人术后胃食管反流症状明显缓解,均停用制酸药物,仅1例病人偶有轻微反酸症状,其余4例症状消失,其他术后并发症少较少。结论腹腔镜胃底折叠联合大弯侧折叠可能成为治疗伴胃食管反流的肥胖症病人的方法之一。

Objective To observe the efficacy of laparoscopic Nissen fundoplication with gastric plication. Methods The clinical data of 6 morbidly obese patients with gastroesophageal reflux disease （GERD） who underwent laparoscopic Nissen fundoplication with gastric plication from March 2012 to July 2013 in Huashan hospital of Fudan University were analyzed retrospectively. Results All procedures were performed via laparoscopic surgery. The mean operative time was 145 （118-170）min. The mean hospital stay after operation was 3.8 （3-5）days. Among them, 1 patient had an acute leak on the second postoperative day and received second operation, which bad a good recovery later but lost in follow up. The other 5 patients were followed up more than 1 year. The mean excess weight loss was 26.8%, 49.1%, 64.3%, 64.0% at 1,3,6 and 12 months respectively. The mean BMI decreased to 25.7（22.7-28.7） 1 year after surgery with a mean body weight loss of 17.8 kg. There were 5 patients combined with diabetes. Among them, postoperative blood-fasting sugar and glycosylated hemoglobin were controlled well （3 complete remission and 2 partial remission）. All metabolic diseases and 5 patients with GERD were relieved after the operation. No anti-acid medication was required in all the patients. Only 1 patient had slight sour regurgitation occasionally and the other 4 patients had no symptoms and few other complications. Conclusion Laparoscopic Nissen fundoplication with gastric plication appears to be an effective and acceptable method for treating morbidly obese patients with GERD.