袖状胃切除术中针对食管裂孔疝行脚修复联合或不联合胃底折叠术：18个月时的反流复发与胸腔内迁移
Crural Repair with or without Fundoplication During Sleeve Gastrectomy for Hiatal Hernia: Reflux Recurrence and Intrathoracic Migration at 18 Months.
文献信息
| PMID | 42799820 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Oktyabr Teshaev |
| 作者单位 | Department ofSurgical Diseases in Family Medicine, Tashkent State Medical University, Tashkent, Uzbekistan. |
| 期刊 | Obesity surgery |
| SCI 分区 | Q1 |
| IF | 3.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言： 袖状胃切除术中发现食管裂孔疝时，脚修复是标准操作，但反流和经裂孔迁移仍持续存在。关于抗反流包裹术是否能增加充分脚修复的价值，数据有限，因为大多数比较系列未在对照组中包括裂孔修复。
方法： 两中心非随机队列，纳入66例连续的重度肥胖合并症状性食管裂孔疝患者，由同一手术团队操作。所有患者均接受腹腔镜袖状胃切除术，使用38 Fr探条，并行后脚修复；31例还接受了保留胃底的胃底折叠术（Nissen < 50岁，Toupet ≥ 50岁），35例未接受。主要结局是18个月时的反流缓解（胃食管反流病问卷评分 < 8且无糜烂性食管炎）。所有患者在18个月时均接受内镜检查。
结果： 最大的基线标准化均数差为0.41。反流缓解率为96.8%对65.7%（差异31.1%，95%置信区间[CI] 12.4-47.8；p = 0.002）。胸腔内迁移影响0/31对8/35例患者（0%对22.9%；p = 0.005）。仅行脚修复后，复发率在不同疝大小间相似（33.3%对34.6%）。多余体重减少（89.1%对87.2%；p = 0.073）和最佳体重反应（87.1%对85.7%）无差异。持续性吞咽困难在胃底折叠术后更常见（16.1%对2.9%；p = 0.091），但所有病例均为轻度，无需扩张或再次手术。
结论： 增加胃底折叠术与更好的症状、内镜和解剖结局相关，且不损害体重减轻。疝大小未能识别出仅行脚修复即足够的患者。
英文摘要
INTRODUCTION: Crural repair is standard when a hiatal hernia is found during sleeve gastrectomy, yet reflux and transhiatal migration persist. Data on whether an antireflux wrap adds value to an adequate crural repair are limited, because most comparative series omit hiatal repair from controls.
METHODS: Two-center non-randomized cohort of 66 consecutive patients with severe obesity and symptomatic hiatal hernia, operated by one surgical team. All underwent laparoscopic sleeve gastrectomy over a 38 Fr bougie with posterior crural repair; 31 also received a fundoplication from the preserved fundus (Nissen < 50 years, Toupet ≥ 50 years) and 35 did not. The primary outcome was reflux remission at 18 months (gastroesophageal reflux disease questionnaire score < 8 without erosive esophagitis). All had endoscopy at 18 months.
RESULTS: The largest baseline standardized mean difference was 0.41. Reflux remission was 96.8% versus 65.7% (difference 31.1%, 95% confidence interval [CI] 12.4-47.8; p = 0.002). Intrathoracic migration affected 0 of 31 versus 8 of 35 patients (0% versus 22.9%; p = 0.005). After crural repair alone, recurrence was similar across hernia sizes (33.3% versus 34.6%). Excess weight loss (89.1% versus 87.2%; p = 0.073) and optimal weight response (87.1% versus 85.7%) did not differ. Persistent dysphagia was more frequent after fundoplication (16.1% versus 2.9%; p = 0.091) but mild in all cases, without dilation or reoperation.
CONCLUSION: Adding a fundoplication was associated with better symptomatic, endoscopic and anatomic outcomes, without impairing weight loss. Hernia size did not identify patients in whom crural repair alone sufficed.