腹腔镜袖状胃切除联合胃底折叠术对肥胖伴胃食管反流病的研究进展

Laparoscopic sleeve gastrectomy in combination with fundoplication for treatment of obesity accompanying gastroesophageal reflux disease

目的总结腹腔镜袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)对胃食管反流病(gastroesophageal reflux disease,GERD)的影响机制及LSG联合胃底折叠术对肥胖伴GERD治疗效果的研究进展。方法检索国内外LSG与GERD关系的相关研究以及LSG联合胃底折叠术与GERD关系研究的相关文献并进行综述。结果LSG对GERD的影响结论不一,但有证据表明,单独LSG可能会恶化原有GERD或新发生GERD,主要是由于食管下括约肌的破坏、His角的钝化、胃内压的升高、袖状胃形状等因素造成。当前已有LSG联合胃底折叠术逐渐应用于临床治疗肥胖伴GERD,短期随访结果发现能达到减重与抗反流的双重效果,但还需要更多研究和更长时间随访来评估其长期疗效。结论LSG后存在恶化原有GERD或新发GERD的风险。LSG联合胃底折叠术具有一定的安全性和可行性,在弥补了单独LSG对GERD不利影响的同时,还达到了同LSG相似的降低体质量的效果,为肥胖伴GERD的患者提供了新的选择。

Objective To summarize the mechanism of effects of laparoscopic sleeve gastrectomy(LSG)on gastroesophageal reflux disease(GERD)and the research progress of LSG in combination with fundoplication on obesity with GERD.Method The literatures of studies relevant to relation between LSG and GERD and effect of LSG combined with fundoplication on obesity accompanying GERD at home and abroad were searched and reviewed.Results Although there was considerable disagreement over the effect of LSG on GERD,the evidence showed that the LSG alone might worsen the existing GERD or promote new GERD,which mainly due to the destruction of the lower esophageal sphincter,deactivation of His angle,elevated intragastric pressure,and shape of sleeve stomach.Currently,the LSG in combination with fundoplication had been gradually applied in the clinical treatment of obese patients with GERD.And the short-term results of follow-up showed that the effects of weight loss and anti-reflux could be obtained,which needed to be evaluated by more studies and longer follow-up.Conclusions There is a risk of worsening existing GERD or promoting new GERD after LSG surgery.The LSG in combination with fundoplication is safe and feasible,which not only makes up for the adverse effects of LSG only on GERD after surgery,but also achieves the same similar effect of weight loss as LSG,providing a new choice for obese patients with GERD.