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

doi:10.3877/cma.j.issn.1674-392X.2024.05.005

中华疝和腹壁外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 501 -506. doi: 10.3877/cma.j.issn.1674-392X.2024.05.005

论著

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

玉素江·图荪托合提¹, 韩琦², 麦麦提艾力·麦麦提明³^,⁴^,⁵, 黄旭东³, 王浩¹, 克力木·阿不都热依木³^,⁴^,⁵, 艾克拜尔·艾力³^,⁴^,⁵^,^†(

)

1.830054 乌鲁木齐，新疆医科大学研究生学院
2.830002 乌鲁木齐，新疆维吾尔自治区人民医院麻醉手术中心手术部
3.830002 乌鲁木齐，新疆维吾尔自治区人民医院微创、疝和腹壁外科
4.830002 乌鲁木齐，新疆胃食管反流病与减重代谢外科临床医学研究中心
5.830002 乌鲁木齐，新疆维吾尔自治区普外微创研究所

收稿日期:2024-08-23 出版日期:2024-10-18
通信作者: 艾克拜尔·艾力
基金资助:
新疆维吾尔自治区重点研发任务专项-厅厅联动项目（2023B03010-3）国家自然科学基金（82060166）

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

Qi Han², Maimaitiming Maimaitiaili²^,³^,⁴^,⁵^,⁶, Xudong Huang³, Hao Wang¹, Abudureyimu Kelimu²^,³^,⁷^,⁶, Aili Aikebaier²^,³^,⁷^,⁶^,^†()

1.Graduate School of Xinjiang Medical University, Urumqi 830054,China
2.Surgical Department of the Surgical Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830002, China
3.Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830002, China
4.Clinical Research Center for Gastroesophageal Reflux Disease
5.and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi 830002, China; 5Research
6.Institute of General and Minimally Invasive Surgery, Xinjiang Uygur Autonomous Region, Urumqi 830002, China
7.Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi 830002, China; 5Research

Received:2024-08-23 Published:2024-10-18
Corresponding author: Aili Aikebaier

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引用本文：

玉素江·图荪托合提, 韩琦, 麦麦提艾力·麦麦提明, 黄旭东, 王浩, 克力木·阿不都热依木, 艾克拜尔·艾力. 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[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 501-506.

Qi Han, Maimaitiming Maimaitiaili, Xudong Huang, Hao Wang, Abudureyimu Kelimu, Aili Aikebaier. Mid-term efficacy analysis of laparoscopic sleeve gastrectomy or combined with hiatal hernia repair in the treatment of obesity with gastroesophageal reflux disease[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 501-506.

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（χ²=62.53，P＜0.001；χ²=26.26，P＜0.001；χ²=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。

关键词: 肥胖症, 胃食管反流病, 疝, 食管裂孔, 疝修补术, 腹腔镜, 袖状胃切除术

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'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's test of sphericity(χ²=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 (F_time=274.5, 12.56, 11.75, P_time＜0.001), while there was no significant difference in intergroup and interaction effects [(F_intergroup=2.17, P_intergroup=0.15; F_interaction=0.64,P_interaction=0.55); (F_intergroup=1.28, P_intergroup=0.26; F_interaction=1.11, P_interaction=0.35); (F_intergroup=0.006, P_intergroup=0.94;F_interaction=0.99, P_interaction=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.

Key words: Obesity, Gastroesophageal reflux disease(GERD), Hernia, hiatal, Hernia repair, Laparoscope, Sleeve gastrectomy

表1 2组患者一般资料比较

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	术前合并症(例)
组别	例数	男性	女性	年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	高血压	糖尿病	糖尿病前期
LSG组	29	13(44.8)	16(55.2)	38±9	40.04±3.63	10	9	8
LSG联合HHR组	16	4(25.0)	12(75.0)	36±8	38.13±3.64	5	5	2
t/χ²值		1.73		0.92	1.69	0.04	0.00	1.36
P值		0.189		0.362	0.098	0.840	0.998	0.244

表1 2组患者一般资料比较

组别	例数	性别[例(%)]		年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	术前合并症(例)
组别	例数	男性	女性	年龄(岁, $\overset{ˉ}{x}$ ±s)	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)	高血压	糖尿病	糖尿病前期
LSG组	29	13(44.8)	16(55.2)	38±9	40.04±3.63	10	9	8
LSG联合HHR组	16	4(25.0)	12(75.0)	36±8	38.13±3.64	5	5	2
t/χ²值		1.73		0.92	1.69	0.04	0.00	1.36
P值		0.189		0.362	0.098	0.840	0.998	0.244

表2 2组患者术中及术后情况比较

组别	例数	手术时间[min,M(范围)]	术中出血量[ml,M(范围)]	术后住院时间[d,M(范围)]	术后30d内再入院(例)
LSG组	29	105(90,125)	80(50,150)	6(4,11)	1
LSG联合HHR组	16	130(115,140)	95(50,175)	6(4,8)	0
Z/Fisher值		-5.39	-0.68	-0.69	-
P值		＜0.001	0.496	0.491	0.644

表2 2组患者术中及术后情况比较

组别	例数	手术时间[min,M(范围)]	术中出血量[ml,M(范围)]	术后住院时间[d,M(范围)]	术后30d内再入院(例)
LSG组	29	105(90,125)	80(50,150)	6(4,11)	1
LSG联合HHR组	16	130(115,140)	95(50,175)	6(4,8)	0
Z/Fisher值		-5.39	-0.68	-0.69	-
P值		＜0.001	0.496	0.491	0.644

表3 2组患者手术前后减重相关指标比较（±s ）

组别	例数	体重指数(kg/m²)
组别	例数	术前	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	40.04±3.63	29.96±3.66	27.54±3.09	27.96±3.69	28.84±4.37
LSG联合HHR	16	38.13±3.64	27.81±3.89	26.55±3.95	26.59±3.74	27.64±4.02
F值		2.857	3.393	0.863	1.415	0.828
P值		0.098^a	0.072^a	0.358^a	0.241^a	0.368^a
组别	例数	%EWL(%)
组别	例数	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	69.84±22.13	85.86±20.87	82.78±25.16	77.60±27.13
LSG联合HHR	16	82.86±24.64	92.60±28.31	91.08±27.07	82.21±27.47
F值		3.295	0.830	1.065	0.294
P值		0.076^a	0.367^a	0.308^a	0.590^a
组别	例数	%TWL(%)
组别	例数	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	25.18±6.26	31.13±5.89	30.03±7.96	27.95±8.63
LSG联合HHR	16	27.12±6.47	30.38±7.66	30.13±8.31	27.32±9.34
F值		0.968	0.134	0.002	0.052
P值		0.331^a	0.716^a	0.969^a	0.820^a

表3 2组患者手术前后减重相关指标比较（±s ）

组别	例数	体重指数(kg/m²)
组别	例数	术前	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	40.04±3.63	29.96±3.66	27.54±3.09	27.96±3.69	28.84±4.37
LSG联合HHR	16	38.13±3.64	27.81±3.89	26.55±3.95	26.59±3.74	27.64±4.02
F值		2.857	3.393	0.863	1.415	0.828
P值		0.098^a	0.072^a	0.358^a	0.241^a	0.368^a
组别	例数	%EWL(%)
组别	例数	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	69.84±22.13	85.86±20.87	82.78±25.16	77.60±27.13
LSG联合HHR	16	82.86±24.64	92.60±28.31	91.08±27.07	82.21±27.47
F值		3.295	0.830	1.065	0.294
P值		0.076^a	0.367^a	0.308^a	0.590^a
组别	例数	%TWL(%)
组别	例数	术后6个月	术后12个月	术后24个月	术后35(28～43)个月
LSG	29	25.18±6.26	31.13±5.89	30.03±7.96	27.95±8.63
LSG联合HHR	16	27.12±6.47	30.38±7.66	30.13±8.31	27.32±9.34
F值		0.968	0.134	0.002	0.052
P值		0.331^a	0.716^a	0.969^a	0.820^a

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

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