外科理论与实践

外科理论与实践 >

2026 , Vol. 31 >Issue 01: 58 - 63

DOI: https://doi.org/10.16139/j.1007-9610.2026.01.10

论著

LSG对肥胖合并Ⅰ型食管裂孔疝病人术后胃食管反流病的影响

  • 孙武青 ,
  • 郭震 ,
  • 姬阆 ,
  • 郝少龙 ,
  • 孙海涛 ,
  • 白日星 ,
  • 韩威
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  • 首都医科大学附属北京潞河医院普外科， 中心实验室， 北京 101149
作者贡献/Authors’contributions

孙武青、郭震负责统计、总结、撰稿；姬阆、郝少龙、孙海涛负责资料收集；白日星、韩威负责指导、审查、修改文章和修订。

白日星，E-mail: brx5168@163.com；
韩威，E-mail：dr-han1972@mail.ccmu.edu.cn

收稿日期: 2025-04-24

  网络出版日期: 2026-04-21

基金资助

通州区卫生发展专项基金(ws-2023-233)

收起

Impact of laparoscopic sleeve gastrectomy on gastroesophageal reflux disease in patients with obesity and type Ⅰ hiatal hernia

  • SUN Wuqing ,
  • GUO Zhen ,
  • JI Lang ,
  • HAO Shaolong ,
  • SUN Haitao ,
  • BAI Rixing ,
  • HAN Wei
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  • Department of General Surgery, Central Laboratory, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China

Received date: 2025-04-24

  Online published: 2026-04-21

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摘要

目的：探讨腹腔镜胃袖状切除术（LSG）对肥胖合并Ⅰ型食管裂孔疝（HH）的病人术后胃食管反流病（GERD）的影响。方法：回顾性分析2023年3月至2024年12月期间收治的肥胖病人63例，分为A组单纯肥胖组（n=50）与B组肥胖合并Ⅰ型HH（n=13）。两组均采取SG手术方式，B组术中未行同期HH修补。通过GERD问卷(Gerd-Q)评分评估术前及术后3、6个月的反流症状，并比较组间差异。结果：两组间术前及术后3、6个月Gerd-Q评分比较差异均无统计学意义（均P>0.05）。两组术后3、6个月分别与术前Gerd-Q评分比较差异均无统计学意义（P>0.05）。两组间术前及术后3、6个月时GERD患病率比较差异均无统计学意义（均P>0.05）。结论：对于肥胖合并Ⅰ型HH的病人，行LSG并没有增加术后GERD的发生率。

关键词： 腹腔镜胃袖状切除术; 食管裂孔疝; 胃食管反流病; 胃食管反流病问卷

本文引用格式

孙武青 , 郭震 , 姬阆 , 郝少龙 , 孙海涛 , 白日星 , 韩威 . LSG对肥胖合并Ⅰ型食管裂孔疝病人术后胃食管反流病的影响[J]. 外科理论与实践, 2026 , 31(01) : 58 -63 . DOI: 10.16139/j.1007-9610.2026.01.10

Abstract

Objective To investigate the effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) after surgery in obese patients with type Ⅰ hiatal hernia (HH). Methods A retrospective analysis was conducted on 63 obese patients admitted between March 2023 and December 2024. The patients were divided into two groups: group A, simple obesity (n=50), and group B, obesity with type ⅠHH (n=13). Both groups underwent SG, and no concurrent HH repair was performed in Group B. Gerd-Q scores were used to evaluate reflux symptoms preoperatively and at 3 and 6 months postoperatively, and the differences between the groups were compared. Results There was no significant difference in the Gerd-Q scores between the two groups before surgery and 3, 6 months after surgery (all P>0.05). When comparing the Gerd-Q scores of the two groups of patients at 3, 6 months after surgery with those before surgery, there were no significant differences (P>0.05). There was no significant difference in the prevalence of GERD between the two groups before surgery and 3, 6 months after surgery (all P>0.05). Conclusions For obese patients with type ⅠHH, undergoing LSG did not increase the incidence of postoperative GERD.

Key words： Laparoscopic sleeve gastrectomy(LSG); Hiatal hernia(HH); Gastroesophageal reflux disease(GERD); Gerd-Q

参考文献

[1] 国家卫生健康委员会. 《中国居民营养与慢性病状况报告(2020年)》[EB/OL]. http://www.gov.cn/xinwen/2020-12/24/content_5572983.htm.
  National Health Commission of the People’S Republic of China. 《China Resident Nutrition and Chronic Disease Survey (2020)》[EB/OL]. http://www.gov.cn/xinwen/2020-12/24/content_5572983.htm.
[2] CLAPP B, PONCE J, DEMARIA E, et al. American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States[J]. Surg Obes Relat Dis, 2022, 18(9):1134-1140.
[3] CHE F, NGUYEN B, COHEN A, et al. Prevalence of hiatal hernia in the morbidly obese[J]. Surg Obes Relat Dis, 2013, 9(6):920-924.
[4] VARELA J E, HINOJOSA M, NGUYEN N. Correlations between intra-abdominal pressure and obesity-related co-morbidities[J]. Surg Obes Relat Dis, 2009, 5(5):524-528.
[5] SUGERMAN H J, DEMARIA E J, FELTON W L, et al. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri[J]. Neurology, 1997, 49(2):507-511.
[6] HILL L D, KOZAREK R A, KRAEMER S J, et al. The gastroesophageal flap valve: in vitro and in vivo observations[J]. Gastrointest Endosc, 1996, 44(5):541-547.
[7] 中华医学会消化病学分会胃肠动力学组, 胃肠功能性疾病协作组, 食管疾病协作组, 等. 中国胃食管反流病诊疗规范[J]. 中华消化杂志, 2023, 43(9):588-598.
  Gastrointestinal Motility Group, Functional Gastrointestinal Disease Group, Esophageal Disease Group, et al. Chinese guidelines for diagnosis and treatment of gastroesophageal reflux disease[J]. Chin J Digest, 2023, 43(9):588-598.
[8] 孙武青, 郭震, 郝少龙, 等. LSG中保留胃窦部及His角完整性对术后胃食管反流病的影响[J]. 中华腔镜外科杂志(电子版), 2024, 17(2):95-99.
  SUN W Q, GUO Z, HAO S L, et al. The effect of preserving the integrity of the gastric antrum and His angle during laparoscopic gastric sleeve resection on postoperative gastroesophageal reflux disease[J]. Chin J Laparo Surg (electronic edition), 2024, 17(2):95-99.
[9] VAKIL N, VAN ZANTEN S V, KAHRILAS P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus[J]. Am J Gastroenterol, 2006, 101(8):1900-1920.
[10] JONES R, JUNGHARD O, DENT J, et al. Development of the GerdQ, a tool for the diagnosis and management of gastro‐oesophageal reflux disease in primary care[J]. Aliment Pharmacol Ther, 2009, 30(10):1030-1038.
[11] 李梦伊, 刘雁军, 王桂琦, 等. 大中华减重与代谢手术数据库2023年度报告[J]. 中国实用外科杂志, 2024, 44(5):552-563,570.
  LI M Y, LIU Y J, WANG G Q, et al. Greater China metabolic and bariatric surgery database registry report(2023)[J]. Chin J Pract Surg, 2024, 44(5):552-563,570.
[12] EUSEBI L H, RATNAKUMARAN R, YUAN Y, et al. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis[J]. Gut, 2018, 67(3):430-440.
[13] DUPREE C E, BLAIR K, STEELE S R, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis[J]. JAMA Surg, 2014, 149(4):328-334.
[14] ZNAMIROWSKI P, BRYK P, LEWITOWICZ P, et al. GERD-a burning problem after sleeve gastrectomy?[J]. Int J Environ Res Public Health, 2021, 18(20):10829.
[15] CHEN W, FENG J, WANG C, et al. Effect of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastroesophageal reflux disease in patients with obesity: a systematic review and meta-analysis[J]. Obes Surg, 2021, 31(9):3905-3918.
[16] WILSON L J, MA W, HIRSCHOWITZ B I. Association of obesity with hiatal hernia and esophagitis[J]. Am J Gastroenterol, 1999, 94(10):2840-2844.
[17] ECE I, YILMAZ H, ACAR F, et al. A new algorithm to reduce the incidence of gastroesophageal reflux symptoms after laparoscopic sleeve gastrectomy[J]. Obes Surg, 2017, 27(6):1460-1465.
[18] HUTOPILA I, CIOCOIU M, PAUNESCU L, et al. Reconstruction of the phreno-esophageal ligament(R-PEL) prevents the intrathoracic migration(ITM) after concomitant sleeve gastrectomy and hiatal hernia repair[J]. Surg Endosc, 2023, 37(5):3747-3759.
[19] EHLERS A P, BONHAM A J, GHAFERI A A, et al. Impact of hiatal hernia repair technique on patient-reported gastroesophageal reflux symptoms following laparoscopic sleeve gastrectomy[J]. Surg Endosc, 2022, 36(9):6815-6821.
[20] KOHN GP, PRICE RR, DEMEESTER SR, et al. Guidelines for the management of hiatal hernia[J]. Surg Endosc, 2013, 27(12):4409-4428.
[21] MILLS H, ALHINDI Y, IDRIS I, et al. Outcomes of concurrent hiatus hernia repair with different bariatric surgery procedures: a systematic review and meta-analysis[J]. Obes Surg, 2023, 33(12):3755-3766.
[22] DESAI M, RUAN W, THOSANI N, et al. American society for gastrointestinal endoscopy guideline on the diagnosis and management of gerd: summary and recommendations[J]. Gastrointest Endosc, 2025, 101(4):267-284.
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