摘要
胃袖状切除术是目前开展最多的减重代谢手术方式。然而,术后胃食管反流病(GERD)较为常见,术后发生的袖状胃胸腔内上移(ITSM)是胃袖状切除术后顽固性胃食管反流病的主要原因,其发生机制受多因素的影响。诊断包括症状诊断及上消化道造影、胃镜检查结果等,经食管测酸测压是诊断GERD的关键手段,对于ITSM的确诊性诊断需通过上腹部CT检查并应用三维重建技术。术前准确诊断食管裂孔疝,术中对胃底部游离充分但不过度、对食管裂孔疝进行确切修复,术后坚持正确的饮食方式,避免肌肉过度减少是预防GERD和ITSM的关键。术后GERD的治疗可先采取保守方式,如严重影响病人日常生活,可针对GERD进行修正手术。然而一旦发生ITSM,通常需要进行修正手术,目前正确的修正手术方式包括袖状胃复位、食管裂孔疝修复,同时将胃袖状切除术修正为标准的Roux-en-Y胃旁路术。
Sleeve gastrectomy is currently the most commonly performed metabolic and bariatric surgery.However,postoperative gastroesophageal reflux disease is a common complication.Intra-thoracic sleeve migration is the main cause of refractory gastroesophageal reflux.The mechanism of its occurrence is influenced by multiple factors.The diagnosis depends on typical symptoms and results from upper gastrointestinal imaging series,endoscopy,etc.Esophageal pH monitoring and manometry are the key standards in the diagnosis of gastroesophageal reflux disease,while the confirmatory diagnosis of intra-thoracic sleeve migration is upper abdominal computed tomography(CT)plus three-dimensional reconstruction technique.Accurate preoperative diagnosis of hiatal hernia,precise intraoperative repair of hiatal hernia,postoperative adherence to correct dietary habits,and avoidance of excessive muscle loss are crucial for the prevention of gastroesophageal reflux disease and intra-thoracic sleeve migration.Initial treatment for postoperative gastroesophageal reflux disease can be conservative.If it severely affects the patient’s daily life,corrective surgery for gastroesophageal reflux disease may be considered.However,in cases of intra-thoracic sleeve migration,corrective surgery is typically required.The current correct approaches for corrective surgery currently include the repositioning of the stomach,the repair of the hiatal hernia,and the modification of the sleeve gastrectomy to a standard Roux-en-Y gastric bypass.
作者
张鹏
张忠涛
ZHANG Peng;ZHANG Zhong-lao(Diision of Metabolic and Bariatric Surgery,General Surgery Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2024年第8期854-857,共4页
Chinese Journal of Practical Surgery
基金
国家重点研发计划项目(No.2022YFC2505204)。
关键词
胃袖状切除术
胃食管反流病
食管裂孔疝
胃胸腔上移
sleeve gastrectomy
gastroesophageal reflux
hiatal hernia
intra-thoracic sleeve migration
