国际指南(共识)中胃袖状切除术病人胃食管反流病的处理建议解读

Interpretation of international guidelines(consensus)for the management of gastroesophageal reflux disease in patients with sleeve gastrectomy

肥胖已成为全球性公共卫生问题。与药物治疗相比,减重代谢手术不但能帮助病人减轻体重、降低病死率、还能使其获得长期稳定的健康。腹腔镜胃袖状切除术(LSG)作为减重代谢手术中的一种,因不改变正常解剖结构、简便易行、并发症少的特点,已成为治疗肥胖症的最优术式。胃食管反流病(GERD)作为LSG的常见并发症,一旦处理不当将严重影响手术效果和病人预后,所以近年来越发受到临床关注。临床医师在基于国内外诊治指南基础的同时,应做好病人术前GERD的检查工作,对肥胖合并GERD的病人予以合理方式进行治疗。对接受LSG的病人,应遵循个体化治疗原则,做好术中精细操作,制定方案应对SG后GERD的发生,进一步提升病人减重效果和预后。

Obesity has become a global public health problem.Compared with drug therapy,Bariatric metabolic surgery(MBS)can not only help patients lose weight,reduce mortality,but also achieve long-term stable health.Laparoscopic sleeve gastrectomy(LSG),as one of MBS,has become the best operation for the treatment of obesity.Because it does not change the normal anatomical structure,is simple,and has few complications.Gastroesophageal reflux disease(GERD),as a common complication of LSG,has been paid more and more attention in recent years because it will seriously affect the surgical effect and patient prognosis once it is not properly handled.Based on domestic and foreign diagnosis and treatment guidelines,clinicians should do a good job of preoperative GERD examination,and provide reasonable treatment for obese patients with GERD.For patients receiving LSG,the principle of individualized treatment should be followed,fine intraoperative operations should be done,and plans should be formulated to deal with the occurrence of GERD after SG,so as to further improve the weight loss effect and prognosis of patients.