腹腔镜胃袖状切除术对胃食管反流病的影响

The effect of laparoscopic sleeve gastrectomy on gastroesophageal reflux disease

目的:探讨肥胖患者胃食管反流病(gastroesophageal reflux disease,GERD)情况及腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)对GERD的影响。方法:2015年11月至2016年10月113例肥胖患者接受LSG,其中男21例,女92例;平均(30±8)岁。采用反流性疾病问卷(reflux diagnostic questionnaire,RDQ)进行评估,评分≥12则诊断为GERD。结果:术前符合GERD的患者共12例,患病率为10.6%(12/113)。随访12个月,9例RDQ评分<12分,缓解率为75%(9/12)。LSG术后GERD新发率为29.7%(30/101),其中66.7%(20/30)口服质子泵抑制剂治疗,50%(10/20)症状可缓解;未服用药物者,90%(9/10)症状明显改善。LSG术后12个月,新发GERD率为10.9%(11/101)。结论:肥胖患者GERD患病率显著增高,行LSG术后症状多可明显改善。LSG术后有新发GERD的风险,患者症状多可有效缓解,但仍有少部分持续存在。

Objective： To investigate the prevalence of gastroesophageal reflux disease（ GERD） in obese patients and the effect of laparoscopic sleeve gastrectomy（ LSG） on GERD. Methods： A total of 113 patients underwent LSG from Nov. 2015 to Oct. 2016,there were 21 men and 92 women with a mean age of（ 30 ± 8）. All patients were followed up for 12 months after LSG. The perioperative and postoperative GERD symptoms were evaluated using reflux diagnostic questionnaire（ RDQ）,and GERD diagnosis was considered positive if RDQ ≥ 12. Results： Twelve patients were diagnosed with GERD（ 10. 6%） preoperatively. The remission rate was 75%（ 9/12） with 9 patients＇ RDQ 12 postoperatively. 30 patients（ 29. 7%） showed new-onset GERD after LSG,of which 20 were treated with proton pump inhibitor and 10 remitted. 90%（ 9/10） of new-onset GERD patients without medicine therapy had the alleviation.10. 9%（ 11/101） patients met the diagnostic criteria of new-onset GERD 12 months after LSG. Conclusions： The prevalence of GERD is markedly increased in the obese patients,and symptoms of GERD can be significantly improved after LSG. The risk of new-onset GERD exists after LSG and can be remitted effectively,yet a minority of patients with new-onset GERD may suffer from persisted symptoms.