胃袖状切除术联合膈肌脚塑形术对术后胃食管反流的影响

Effect of sleeve gastrectomy combined with crura of diaphragm plasticity on gastroesophageal reflux disease after sleeve gastrectomy

目的评估腹腔镜胃袖状切除术(LSG)联合膈肌脚塑形术对LSG术后胃食管反流病(GERD)的影响。方法收集2022年6月至2023年3月复旦大学附属华山医院33例接受LSG或LSG联合膈肌脚塑形术的并按时完成随访的患者的临床资料,按手术方式分为2组。LSG组18例,LSG+膈肌脚塑形组15例。比较2组围手术期情况、术后减重效果及GERD情况。结果2组患者均成功实施腹腔镜手术,无增加戳孔或中转开腹的情况,未出现大出血、肠道损伤等术中并发症。LSG组平均手术时间为(97.06±23.28)min,术中出血量为(34.72±19.59)ml,术后住院时间为(3.44±0.78)d;LSG+膈肌脚塑形组平均手术时间为(100.33±14.82)min,术中出血量为(31.33±5.16)ml,术后住院时间为(3.47±0.74)d,2组差异均无统计学意义(P>0.05)。术后1个月,2组患者%EWL和%TWL比较,差异均无统计学意义(P>0.05);LSG组GERD-Q评分为(6.89±1.53)分,LSG+膈肌脚塑形组为(6.80±1.37)分,2组差异均无统计学意义(P>0.05);LSG组GERD-Q评分≥8分的患者共5例(27.78%),LSG+膈肌脚塑形组中有4例(26.67%),2组差异均无统计学意义(P>0.05)。术后6个月,2组患者%EWL和%TWL比较,差异均无统计学意义(P>0.05);LSG组患者GERD-Q评分为(6.06±0.24)分,LSG+膈肌脚塑形组为(6.40±1.12)分,2组差异均无统计学意义(P>0.05);LSG组GERD-Q评分≥8分的患者共0例(0.00%),LSG+膈肌脚塑形组2例(13.33%),2组差异均无统计学意义(P>0.05)。结论LSG联合膈肌脚塑形相较于LSG并不会延长手术时间、增加手术并发症以及影响术后康复,且对LSG术后GERD情况无显著影响。

Objective To evaluate the effect of laparoscopic sleeve gastrectomy(LSG)combined with crura of diaphragm plasticity on gastroesophageal reflux disease(GERD)after LSG.Methods Clinical data of 33 patients with obesity who underwent LSG or LSG combined with crura of diaphragm plasticity from June 2022 to March 2023 and completed follow-up in time were retrospectively analyzed.Group as surgical method,there were 18 cases in LSG group and 15 cases in LSG combined with crura of diaphragm plasticity group.Perioperative indicators,improvement of obesity and severity of GERD were compared in these two groups.Results All procedures were performed via laparoscopic surgery.In LSG group,mean operative time was(97.06±23.28)min,volume of intraoperative blood loss was(34.72±19.59)ml,hospital stay after operation was(3.44±0.78)d.In LSG combined with crura of diaphragm plasticity group,mean operative time was(100.33±14.82)min,volume of intraoperative blood loss was(31.33±5.16)ml,hospital stay after operation was(3.47±0.74)d,with no statistical significance between the two groups(P>0.05).One month after surgery,there was no significant difference in%EWL and%TWL between the two groups(P>0.05).The GERD-Q score of LSG group was(6.89±1.53)points,and that of LSG combined with crura of diaphragm plasticity group was(6.80±1.37)points,with no statistical significance between the two groups(P>0.05).There were 5 patients(27.78%)with GERD-Q score≥8 points in LSG group,and 4 patients(26.67%)in LSG combined with crura of diaphragm plasticity group,with no statistical significance between the two groups(P>0.05).Six months after surgery,there was no significant difference in%EWL and%TWL between the two groups(P>0.05).The GERD-Q score of LSG group was(6.06±0.24)points,and that of LSG combined with crura of diaphragm plasticity group was(6.40±1.12)points,with no statistical significance between the two groups(P>0.05).There were 0 patients(0.00%)with GERD-Q score≥8 points in LSG group,and 2 patients(13.33%)in LSG combined with crura of diaphragm plasticity group,with no statistical significance between the two groups(P>0.05).Conclusion Compared with LSG,LSG combined with crura of diaphragm plasticity did not prolong operation time,increase surgical complications and affect postoperative rehabilitation,and had no significant effect on GERD after LSG.