肥胖合并胃食管反流病的外科治疗研究进展

Advances in the Surgical Treatment of Obesity Combined with Gastroesophageal Reflux Disease

摘要: 众所周知，肥胖合并代谢综合征的患者逐年增多。目前国内外最常用的减重手术方式为腹腔镜下袖状胃切除术(Laparoscopic Sleeve Gastrectomy, LSG)，被广大肥胖合并代谢综合征的患者所接受。然而很多肥胖患者合并有胃食管反流病(Gastroesophageal Reflux Disease, GERD)和(或)食管裂孔疝(Hiatus Hernia, HH)，如对这些患者行LSG，则术后新发GERD或原有的GERD症状加重。肥胖合并GERD患者的外科治疗选择仍是诊治工作的难点。肥胖合并GERD和(或) HH不但增加手术难度，还对术者提出更高的要求。因此选择合理的术式具有重要的临床价值。本文旨在肥胖合并胃食管反流病的临床特征病理改变以及相关手术方式的选择和优缺点方面作一综述。

Abstract: As we all know, the number of obese patients with metabolic syndrome is increasing year by year. At present, the most commonly used weight-loss surgery at home and abroad is laparoscopic sleeve gastrectomy (LSG), which is accepted by the majority of obese patients with metabolic syndrome. However, many obese patients have gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH). If LSG is performed on these patients, the symptoms of new GERD or original GERD will worsen. The choice of surgical treatment for obese patients with GERD is still a difficult point in diagnosis and treatment. Obesity combined with GERD and/or HH not only increases the difficulty of surgery, but also puts forward higher requirements for the operator. Therefore, it is of great clinical value to choose a reasonable operation. The purpose of this article is to review the clinical features and pathological changes of obesity complicated with gastroesophageal reflux disease, as well as the selection, advantages and disadvantages of relevant surgical methods.