腹腔镜袖状胃切除或联合食管裂孔疝修补术对肥胖症合并胃食管反流病的中期疗效分析

Mid-term efficacy analysis of laparoscopic sleeve gastrectomy or combined with hiatal hernia repair in the treatment of obesity with gastroesophageal reflux disease

目的探讨腹腔镜袖状胃切除(LSG)或联合食管裂孔疝修补术(HHR)治疗肥胖症合并胃食管反流病(GERD)的临床疗效。方法回顾性分析2020年1月至2021年4月,新疆维吾尔自治区人民医院收治并完成随访的45例肥胖症合并GERD患者的临床资料,根据手术方式分为LSG联合HHR或者单纯LSG组,比较分析2组患者减重效果及合并症改善情况。结果共51例患者,失访6例,其余45例患者均获得术前及术后资料,中位随访时间为35(28~43)个月。45例患者中,16例通过术前检查及术中探查发现食管裂孔疝并行LSG联合HHR,其余29例行LSG。(1)2组患者术前一般资料比较,差异均无统计学意义(P>0.05)。(2)2组患者术中及术后情况比较,LSG联合HHR手术时间较LSG组更长,差异有统计学意义(Z=-5.39,P<0.001),术中出血量、术后住院时间、术后30 d内再入院率和胆囊结石发生率差异均无统计学意义(P>0.05)。(3)2组患者体重指数、多余体重减少百分比和总体重减轻百分比均不满足球形检验(χ^(2)=62.53,P<0.001;χ^(2)=26.26,P<0.001;χ^(2)=29.45,P<0.001),多变量检验结果显示,上述指标时间效应比较,差异均有统计学意义(F时间=274.5,P时间<0.001;F时间=12.56,P时间<0.001;F时间=11.75,P时间<0.001);组间效应和交互效应比较,差异均无统计学意义(F组间=2.17、P组间=0.15,F交互=0.64、P交互=0.55;F组间=1.28、P组间=0.26,F交互=1.11、F交互=0.35;F组间=0.006、P组间=0.94,F交互=0.99,P交互=0.40)。(4)术前与术后胃食管反流病问卷量表评分比较,LSG联合HHR组患者从9(8,12)分降至7(6,11)分,差异有统计学意义(P<0.05);LSG组患者从9(8,11)分降至8(6,15)分,差异无统计学意义(P=0.186)。结论LSG联合HHR手术和单纯LSG手术均可显著降低肥胖症患者的体重指数,并有效改善肥胖症相关合并症。LSG联合HHR手术可显著改善肥胖症患者的GERD症状,而LSG术后肥胖症患者GERD症状无明显变化。

Objective To explore the clinical efficacy of laparoscopic sleeve gastrectomy(LSG)or combined with hiatal hernia repair(HHR)in the treatment of obesity with gastroesophageal reflux disease(GERD).Methods A retrospective analysis was performed on 45 obese patients with GERD who admitted to People&apos;s Hospital of Xinjiang Uygur Autonomous Region from January 2020 to April 2021 and completed the follow-up.Patients were divided into LSG combined with HHR group or LSG alone group according to the surgical method,and weight loss effects and improvement of comorbidities between two groups of patients were compared and analyzed.Results Among the 51 obese patients,six patients were lost to follow-up,and preoperative and postoperative data were obtained for the remaining 45 patients,the median follow-up time was 35(28-43)months.Among the 45 patients,16 patients were found to have hiatal hernia through preoperative examination and intraoperative exploration,and underwent LSG+HHR,while the remaining 29 patients underwent LSG.(1)There was no significant difference in the preoperative general information between two groups(P>0.05).(2)The comparison of intraoperative and postoperative conditions between two groups showed that the LSG combined with HHR had a longer surgical time than the LSG group,and there was a significant difference(Z=-5.39,P<0.001).There was no significant difference in the volume of intraoperative blood loss,postoperative hospital stays,readmission within 30 days after surgery,and incidence of gallbladder stones between two groups(P>0.05).(3)The body mass index,%EWL and%TWL among the two groups did not meeting the mauchly&apos;s test of sphericity(χ^(2)=62.53,26.26,29.45,P<0.001).The results of multi-variate test showed that there was a significant difference in the time effect of the above indexes(Ftime=274.5,12.56,11.75,Ptime<0.001),while there was no significant difference in intergroup and interaction effects[(Fintergroup=2.17,Pintergroup=0.15;Finteraction=0.64,Pinteraction=0.55);(Fintergroup=1.28,Pintergroup=0.26;Finteraction=1.11,Pinteraction=0.35);(Fintergroup=0.006,Pintergroup=0.94;Finteraction=0.99,Pinteraction=0.40)].(4)The Gastroesophageal reflux disease questionnaire(Gerd Q)score of patients in the LSG combined with HHR group decreased from 9(8,12)points before surgery to 7(6,11)points after surgery,and there was a significant difference(P<0.05).The Gerd Q score of patients in the LSG group decreased from 9(8,11)points to 8(6,15)points,with no statistically significant difference(P=0.186).Conclusion LSG combined with HHR and LSG alone can significantly reduce body mass index in obese patients and effectively improve obesity related comorbidities.LSG combined with HHR can significantly improve GERD symptoms in obese patients,but there is no significant change in GERD symptoms after LSG.