中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (08): 911-915.DOI: 10.19538/j.cjps.issn1005-2208.2024.08.15

• 论著 • 上一篇    下一篇

胃袖状切除术与胃袖状切除联合双通路术术后胃食管反流病对比研究

姚立彬1a,2，于英华2，李胜利1b，王    键1a,2，洪    健1a,2，邵    永1a,2，朱孝成1a,2   

  1. 1 徐州医科大学附属医院  a.减重代谢外科  b.临床研究院，江苏徐州 221006；2 徐州医科大学国际肥胖及代谢病中心，江苏徐州 221004
  • 出版日期:2024-08-01 发布日期:2024-08-23

  • Online:2024-08-01 Published:2024-08-23

摘要： 目的    对比胃袖状切除术（SG）与胃袖状切除联合双通路术（SG-TB）术后胃食管反流病（GERD）新发与缓解情况。方法    回顾性分析2022年1—12月在徐州医科大学附属医院接受SG或SG-TB手术的195例病人的临床资料，根据术式不同分为SG组（96例）和SG-TB组（99例）。共随访12个月，比较两组术前基本资料及术后体重变化，根据GERD问卷（GERD-Q）与胃镜检查结果对比术后GERD与食管炎新发和缓解情况，采用logistic回归分析术后新发GERD的影响因素。结果    两组病人术前年龄、性别比例、体重、BMI、合并高血压、高脂血症及食管炎比例等差异无统计学意义（P>0.05）。SG组术前合并GERD、2型糖尿病比例低于SG-TB组，差异有统计学意义（P<0.05）。术后12个月，SG组总体重减轻百分比（%TWL）［（30.5±6.3）% vs.（ 35.9±7.8）%，P<0.001］和多余体重减轻百分比（%EWL）［（85.8±22.1）% vs. （106.5±27.2）%，P<0.001］明显低于SG-TB组，差异有统计学意义；SG-TB组GERD缓解率明显高于SG组（85.0% vs. 22.2%，P=0.002），GERD新发率低于SG组（7.6% vs. 25.3%, P=0.002）；两组食管炎缓解率和新发率差异无统计学意义（P>0.05）。Logistic回归分析显示SG为术后新发GERD的独立危险因素（OR=2.725，95%CI 1.120~6.633，P=0.027）。结论    同SG术式相比，SG-TB手术可明显缓解术前合并的GERD并降低术后新发GERD比例，对肥胖术前合并有GERD病人可以考虑实施SG-TB手术。

关键词: 胃袖状切除术, 胃袖状切除联合双通路手术, 胃食管反流病, 肥胖

Abstract: To compare the incidence and relief of gastroesophageal reflux disease (GERD) after sleeve gastrectomy (SG) versus sleeve gastrectomy with transit bipartition (SG-TB). Methods    A retrospective analysis was conducted on the clinical data of 195 patients who underwent SG or SG-TB surgery at the Affiliated Hospital of Xuzhou Medical University from January to December 2022 were retrospectively analyzed. All patients were divided into SG groups (n=96) and SG-TB groups (n=99) based on the surgical procedure. The total followed up time was 12 months. Preoperative baseline data and postoperative weight changes were compared between the two groups. The incidence and relief of postoperative GERD and esophagitis were compared based on GERD-Q scores and gastroscopy results. The influencing risk factors of the postoperative new GERD were analyzed by logistic regression. Results    There were no significant statistical differences in preoperative age, gender, weight, BMI, or the prevalence of hypertension or hyperlipidemia between the two groups (P>0.05). The SG group had lower preoperative rates of GERD and T2DM than the SG-TB group, and the difference was statistically significant (P<0.05). 12 months after surgery, the total weight loss percentage (%TWL) ［(30.5±6.3)% vs. (35.9±7.8)%, P<0.001)］ and the excess weight loss percentage (%EWL) ［(85.8±22.1)% vs. (106.5±27.2)%, P<0.001)］ in the SG group was significantly lower than that in the SG-TB group, and the difference was statistically significant; the remission rate of GERD in the SG-TB group was significantly higher than that in the SG group (85.0% vs. 22.2%, P=0.002), and the new incidence rate of GERD was lower than that in the SG group (7.6% vs. 25.3%, P=0.002); there was no significant difference in remission rate and new incidence rate of esophagitis between the two groups (P>0.05). Logistic regression analysis indicated that SG was an independent risk factor for new postoperative GERD (OR=2.725, 95%CI 1.120-6.633, P=0.027). Conclusion    Compared to SG, SG-TB surgery can significantly alleviate preoperative GERD and reduce the rate of new-onset GERD postoperatively. For obese patients with preoperative GERD, SG-TB surgery can be considered. 

Key words: sleeve gastrectomy, sleeve gastrectomy with transit bipartition, gastroesophageal reflux disease, obesity