- 學位論文
逆流性食道炎嚴重度在胃縮小手術一年後的變化及其相關因子
Changes in Severity of Erosive Esophagitis One Year After Laparoscopic Sleeve Gastrectomy and Associated Factors
摘要
研究背景：胃縮小手術是目前最普遍的代謝及減重手術，減重後理論上可以減少胃食道逆流，但胃縮小手術對於胃結構性的破壞反而可能使得胃食道逆流惡化，目前胃縮小手術對胃食道逆流的影響仍不清楚。我們評估術前和術後一年逆流性食道炎嚴重度的變化，來觀察胃縮小手術對於胃食道逆流的影響。 研究方法：回顧性分析2007年2月至2016年3月接受胃縮小手術患者的資料，包括術前和術後一年的人體測量學數據、抽血檢驗及內視鏡檢查結果，而逆流性食道炎的嚴重程度依據洛杉磯分類進行評估。 結果：316名患者的平均追蹤時間為13個月。逆流性食道炎盛行率及嚴重程度在胃縮小手術後1年明顯增加。術前逆流性食道炎的患者為96例（30.4％），所有患者均為A和B級。術後一年逆流性食道炎的患者增加為215例（68％），A級為136例（43％），B級為62例（19.6％），C級加D級為17例（5.4％），新形成逆流性食道炎的患者為127例（40.2％）。術前無逆流性食道炎及逆流性食道炎A級的患者於術後演變成嚴重逆流性食道炎的發生率分別為3.2%及6.8%。術後逆流性食道炎的獨立危險因子為男性（OR=3.60，95％CI=1.87-6.96）、術後有橫膈疝氣（OR=3.91，95％CI=1.63-9.35）及術前有逆流性食道炎（OR=5.20，95％CI=2.31-11.70）。將所有患者分為逆流性食道炎嚴重度無變化或降低（n=150）及逆流性食道炎嚴重度增加（n=166）兩組作分析。術後逆流性食道炎嚴重度增加的獨立危險因子為男性（OR=2.55，95％CI=1.52-4.28）及術後有橫膈疝氣（OR=3.17，95％CI=1.66-6.06），而術前有逆流性食道炎的患者於術後食道炎嚴重度常維持不變或嚴重度降低（OR=0.25，95％CI=0.13-0.46）。 結論：胃縮小手術後一年，逆流性食道炎的盛行率及嚴重度顯著增加，其與男性及術後有橫膈疝氣相關。術前無逆流性食道炎及逆流性食道炎A級的患者於術後產生嚴重逆流性食道炎的發生率並不高。
並列摘要
Background: Laparoscopic sleeve gastrectomy (LSG) is a popular metabolic and bariatric surgery for weight reduction. Theoretically weight reduction would decrease gastroesophageal reflux disease (GERD) but damages to the structure of stomach may inversely worsen GERD. Therefore, the relationship between LSG and GERD is still unclear. We aimed to evaluate erosive esophagitis (EE) before and 1 year after LSG to elucidate the effect of LSG on GERD. Method: The data of patients who underwent LSG between February 2007 and March 2016 were retrospectively reviewed. The endoscopic findings, demographic and anthropometric data before and one year after surgery were recorded. The severity of EE was assessed according to the Los Angeles (LA) classification. Results: We enrolled 316 patients and the mean follow up time was 13 months (range, 12–23). One year after LSG, the prevalence and severity of EE increased significantly. Before LSG, 96 patients (30.4%) were found to have EE, and all cases were grade A and B. After surgery, 215 patients (68%) had EE, including 136 (43%) with grade A, 62 (19.6%) with grade B, and 17 (5.4%) with grade C and D. Totally, 127 patients (40.2%) developed de novo EE following LSG. The incidence of severe EE after LSG in patients without preoperative EE and with grade A EE at baseline were 3.2% and 6.8%, respectively. Independent risk factors of EE following LSG were male gender (OR=3.60, 95%CI=1.87-6.96), post-operative hiatal hernia (OR=3.91, 95%CI=1.63-9.35) and pre-operative EE (OR=5.20, 95%CI=2.31-11.70). Patients were divided into two groups, non-progressive severity of EE (n=150) and progressive severity of EE (n=166). Independent risk factors of progressive severity of EE after LSG were male gender (OR=2.55, 95%CI=1.52-4.28) and post-operative hiatal hernia (OR=3.17, 95%CI=1.66-6.06). The presence of pre-operative EE had a negative association with progressive severity of EE (OR=0.25, 95%CI=0.13-0.46) Conclusion: The prevalence and severity of EE increases significantly 1 year after LSG which is associated with male gender and post-operative hiatal hernia. The incidence of severe EE after LSG in patients without preoperative EE and with grade A EE at baseline is not high.