10 年随访胃旁路术后胃食管反流相关因素分析：回顾性单中心研究。
Analysis of Factors Related to Gastroesophageal Reflux After Gastric Bypass at 10-Year Follow-up: A Retrospective Single-institutional Study.
机构信息
Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy;
Department of Digestive Surgery, CHU Félix Guyon, Saint-Denis, France.
出版信息
In Vivo. 2024 Mar-Apr;38(2):982-989. doi: 10.21873/invivo.13531.
BACKGROUND/AIM: Long-term gastroesophageal reflux (GERD) after gastric bypass for obesity is underestimated. The present study aimed to evaluate the rate of treated GERD and the factors influencing it in a cohort of patients who underwent gastric bypass.
PATIENTS AND METHODS
Patients who underwent one-anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) as a primary bariatric procedure between 2010 and 2011 at a French private referral center were included in the study. The primary endpoint was the 10-year prevalence of GERD.
RESULTS
In total, 422 patients underwent RYGB and 334 underwent OAGB with a biliopancreatic limb of 150 cm. The mean age was 38.9±11.3 years, and 81.6% of patients were female; the mean preoperative body mass index was 42.8±5 kg/m Preoperative GERD was diagnosed in 40.8% of patients in the total cohort, 31.7% in the RYGB group versus 49.1% in the OAGB group (p<0.0001). At 10-year follow-up, the rate of GERD was 21.1%, with no difference between the two groups. Remission of preoperative GERD and de novo GERD were comparable between the two types of bypass. Surgery for GERD resistant to medical treatment was more frequent in the OAGB group. At multivariate analysis, factors significantly correlated with long-term GERD were: Preoperative GERD, total weight loss at 120 months <25%, glycemic imbalances and anastomotic ulcers.
CONCLUSION
Identification and correction of modifiable factors may help reduce the incidence of long-term GERD.
背景/目的：肥胖症胃旁路手术后长期胃食管反流（GERD）被低估。本研究旨在评估接受胃旁路手术患者中经治疗的 GERD 发生率及其影响因素。
患者和方法
研究纳入了 2010 年至 2011 年期间在法国一家私人转诊中心接受单吻合胃旁路术（OAGB）或 Roux-en-Y 胃旁路术（RYGB）作为主要减肥手术的患者。主要终点是 10 年 GERD 患病率。
结果
共 422 例患者接受了 RYGB，334 例患者接受了 OAGB，胆胰支长度为 150cm。患者平均年龄为 38.9±11.3 岁，81.6%为女性；术前平均体重指数为 42.8±5kg/m2。术前 GERD 在总队列中诊断率为 40.8%，RYGB 组为 31.7%，OAGB 组为 49.1%（p<0.0001）。10 年随访时，GERD 发生率为 21.1%，两组之间无差异。两种旁路手术的术前 GERD 缓解和新发 GERD 相当。对药物治疗无效的 GERD 进行手术治疗的情况在 OAGB 组更为常见。多变量分析显示，与长期 GERD 显著相关的因素包括：术前 GERD、120 个月时总体重减轻<25%、血糖失衡和吻合口溃疡。
结论
识别和纠正可改变的因素可能有助于降低长期 GERD 的发生率。
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