腹腔镜胃袖状切除术后胃食管返流的研究

Gastroesophageal reflux after laparoscopic sleeve gastrectomy

胃食管返流的患病率逐渐增高,其相关发病因素多样,肥胖被认为是其重要的影响因素之一。面对肥胖发生率的逐年增加,解决肥胖及其并发症问题已变得刻不容缓。随着减重代谢手术的出现,这一问题已经逐步得到解决。减重代谢手术解决肥胖问题具有高效安全等优势,在世界范围内得以广泛应用,并随之产生了多种手术术式。作为当前减重手术中应用最为广泛的腹腔镜胃袖状切除术,在解决病人肥胖问题后,对病人胃食管返流情况的影响仍有较大争议。胃袖状切除术后,部分病人胃食管返流症状得以缓解,也有相当多的病人术后胃食管返流症状明显加重。本文综述了肥胖与胃食管返流的关系,腹腔镜胃袖状切除术对肥胖病人胃食管返流的影响以及术后病人胃食管动力学改变,讨论腹腔镜胃袖状切除术后应用高分辨率食道测压技术诊断病人术后胃食管返流的意义。

The prevalence of gastroesophageal reflux disease has gradually increased over the past few decades,according to the current research,we know that its related factors are various.Remarkablely,obesity is considered to be one of its important influencing factors.Facing the current increasing incidence of obesity year by year,it is urgent to solve the problem of obesity and its related complications around the word.Fortunately,with the appearance of bariatric metabolic surgery,this problem has been solved gradually.Because of the advantages of high efficiency and safety in solving the problem of obesity,bariatric metabolic surgery has been widely used in the world,and a variety of surgical methods have been produced to adapt to different patients.However,laparoscopic sleeve gastrectomy,as the most widely used in current bariatric metabolic surgery,the influence on gastroesophageal reflux disease is still controversial after solving the problem of obesity and its complications in patients. Some articles pointed out that after laparoscopic sleeve gastrectomy,the symptoms of gastroesophageal reflux were relieved in some patients,however,some articles pointed out that the symptoms of gastroesophageal reflux in a considerable number of patients were significantly aggravated. This paper reviews the relationship between obesity and gastroesophageal reflux diease,the influence of laparoscopic sleeve gastrectomy on gastroesophageal reflux in obese patients,and the changes of gastroesophageal dynamics in patients after laparoscopic sleeve gastrectomy,and then further discusses the significance of high-resolution esophageal manometry in the diagnosis of postoperative gastroesophageal reflux diease.