减重代谢手术预防胃食管反流病的研究进展

Research progress of bariatric and metabolic surgery in the prevention of gastroesophageal reflux disease

胃食管反流病(GERD)是常见的消化道疾病。肥胖是GERD的一个独立危险因素。腹腔镜袖状胃切除术(LSG)在减重代谢手术中越来越普及,并且操作简单、并发症较少,但在治疗肥胖患者术后抗反流疗效方面仍存在争议。有研究报道,LSG可能破坏抗反流屏障功能,如His角功能改变、膈肌连续性的破坏以及术后食管裂孔疝增加。His角是胃食管连接处的重要抗反流屏障之一,重建His角已被证实能有效缓解GERD症状,LSG联合His重建术有望成为有效预防肥胖术后GERD的措施。因此,本文主要就减重手术预防GERD的研究做一综述,旨在探讨肥胖患者术后GERD的有效治疗,以改善患者GERD的症状以及其生活质量,为GERD的外科治疗提供借鉴。

Gastroesophageal reflux disease(GERD)is a common digestive tract disease.Obesity is an independent risk factor for GERD.Laparoscopic sleeve gastrectomy(laparoscopic sleeve gastrectomy,LSG)is becoming more popular in bariatric metabolic surgery and is simple to perform with fewer complications,but its efficacy in treating postoperative anti-reflux in obese patients remains controversial.LSG has been reported to disrupt anti-reflux barrier function,such as altered cardiac notch,disruption of diaphragmatic continuity,and increased hiatal hernia after surgery.The cardiac notch is one of the important anti-reflux barriers at the gastroesophageal junction,and its accentuation has been shown to be effective in alleviating the symptoms of GERD,and LSG combined with angle of cardiac notch accentuation is expected to be an effective measure to prevent GERD after obesity surgery.Therefore,this article mainly reviews the research on the prevention of GERD by bariatric surgery,aiming to explore the effective treatment of GERD in obese patients after surgery,so as to improve the symptoms and quality of life of patients with GERD,and provide reference for the surgical treatment of GERD.