腹腔镜胃底折叠术联合胃袖状切除术治疗肥胖合并胃食管反流病临床研究

目的 探讨腹腔镜胃底折叠术联合胃袖状切除术（LFDSG）治疗肥胖合并胃食管反流病（GERD）的临床疗效。方法 前瞻性分析自2017年5月至2018年5月在新疆维吾尔自治区人民医院腹腔镜、腹壁疝外科收治的60例符合减重手术适应证的肥胖病人的临床资料。依据手术方式分为LSG组（30例）和LFDSG组（30例）。两组术后随访12个月，观察病人术后减重和抗反流效果。结果 两组术后12个月的BMI和多余体重减少百分比（%EWL）与术前比较差异有统计学意义（P<0.05）。与LSG组相比，LFDSG组GERD症状缓解评分（8~13分及14~18分）分布以及术后12个月酸反流（pH≤4）次数、食管近端酸反流（%）、DeMeester评分、食管下段括约肌残余压、食管远端收缩积分的差异均有统计学意义（P<0.05）。LFDSG组治疗后抗反流有效率显著高于LSG组［28例（93.3%） vs. 21例（70.0%），P<0.05］。LFDSG组病人无并发症发生，LSG组病人住院期间1例发生并发症，出院后3例发生并发症。两组均无死亡病例。结论 LFDSG治疗肥胖合并GERD的效果较好，可达到抗反流与减重的双重目的，有效防治GERD的发生与发展。

Clinical study of laparoscopic fundoplication with sleeve gastrectomy for obesity combined with gastroesophageal reflux disease

Clinical study of laparoscopic fundoplication with sleeve gastrectomy for obesity combined with gastroesophageal reflux disease Pierdiwasi·Maimaitiyusupu*，Aikebaier·Aili，Maimaiti·Yisireyili，et al. *Xinjiang Medical University Graduate School of Medicine，Urumqi 830054，China
Corresponding author：Kelimu·Abudureyimu，E-mail: klm6075@163.com
Abstract Objective To investigate the weight loss and anti-reflux effect of laparoscopic fundoplication with sleeve gastrectomy (LFDSG) in obese patients with gastroesophageal reflux disease (GERD). Methods A prospective analysis was made on 60 obese patients whom were admitted to Department of Laparoscopic and Abdominal Hernia Surgery in the People's Hospital of Xinjiang Uygur Autonomous Region between May 2017 to May 2018. Patients were divided into LSG group (30 cases) and LFDSG group (30 cases). The data of GERD Q score，24h pH monitoring and high resolution esophageal manometry of two groups were collected. Results As compare to before-operation，difference of BMI and% EWL in 12 month after-operation in two groups was statistically significant (P<0.05). Compared with LSG group，the differences of GERD score range (8—13 points and 14—18 points)，the changes of acid reflux (pH<4)，proximal esophageal acid reflux (%)，DeMeester score，residual pressure of LES，and distal contractile integral (DCI) in LFDSG group in 12 months after operation in LFDSD group were statistically significant (P<0.05). The effective rate of anti reflux in LFDSG group was significantly higher than that in LSG group ［28 cases (93.3%) vs. 21 cases (70.0%)，P<0.05］. There was no complication in LFDSG group; 1 case in LSG group had complications during hospitalization; 3 case in LSG had complications after discharge. There was no death in both groups. Conclusion LFDSG is an effective method for treating obese patients with GERD. It could reach the dual purpose of anti-reflux and weight loss，and effectively prevent the occurrence and development of GERD.