内镜下手术治疗胃食管反流病37例临床研究

目的探讨内镜下手术治疗胃食管反流性病(GERD)的临床疗效和对患者生活质量的影响。方法做好手术前准备,在全身麻醉CO2气腹下进行,对7例高级不典型增生者,采取内镜下射频治疗+注射疗法,32例用腹腔镜改良NISSen胃底折叠术,其中20例食管裂孔疝患者先行疝修补术;对30例手术后6个月随访到的患者进行术前后对比。结果术后6个月躯体症状改善有效率96.67%;食管动态pH监测显示pH<4时间%术前(7.42±1.93),术后6个月(3.78±2.33);卧位pH<4时间%术前后分别为(3.33±1.54)、(1.95±1.43);pH<4反流次数术前后分别为(61.17±15.20)、(42.17±14.01);最长反流时间(min)术前后分别为(16.91±3.11)、(10.23±3.45);术后GERD患者的酸反流造成食管粘膜酸暴露时间明显缩短,酸反流程度明显减轻,术前、后比较差异有统计学意义(P<0.01);手术前后生活质量比较,生理职能(RP)评分术前(61.54±18.14),术后6个月(81.61±17.35);躯体疼痛(BP)评分术前(70.23±21.32),术后(86.87±14.93);健康变化(HT)术前(59.32±10.04)、术后(85.39±9.77);反映QOL的9项健康维度中除情感职能(RE)外8项健康维度差异均有统计学意义(P<0.01或P<0.05);未见严重并发症发生。结论内镜下手术治疗GERD对改善患者的躯体症状及生活质量有很好的近期效果。

Objective To explore the clinical effects of the operation for gastroesophageal reflux disease （GERD）under endoscopy and the effect of the quality of Life in patients. Methods Before the operation, with the pneumoperitoneum under general anesthesia CO 2, 7 cases of the senior atypical hyperplasia were treated by the radiofrequency ablation and the injection therapy under endoscopy. 32 cases were treated by the modified laparoscopic Nissen fundoplication, 20 cases of the hiatal hernia were treated by the herniorrhaphy firstly. 30 patients who were follow- up visited 6 months after the operation were compared. Results The effective rate of somatic symptoms improvement 6 months after operation was 96.97%. The esophageal dynamic pH monitoring showed that pH 〈4 time% before the operation was （7.42±1.93）, after the operation 6 months was （3.78±2.33）; the pH 〈 4 time% of clinostatism before and after operation was （3.33±1.54）, （1.95±1.43）; the pH 〈 4 regurgitation times before and after operation were （61.17±15.20） and （42.17±14.01）; the longest regurgitation time （min） before and after operation （16.91±3.11） and （10.23±3.45）; the time of esophageal mucosa exposure after acid reflux of GERD patents was shortened obviously, the degree of acid reflux was light obviously, there was significant difference between before and after operation（P〈0.01）, compare the quality of life （QOL） between before and after operation, the score of role physical before and 6 months after the operation was （61.54±18.14） and （81.61± 17.35）, the score of body pain （BP） before and after the operation was（70.23±21.32 ）and （86.87±14.93）, the score of health transformation before and after the operation was（ 59.32±10.04 ）and（ 85.39±9.77）; there were 9 dimensionality to reflect the QOL, except the role emotional（RF）, 8 dimensionality of the health was significant difference （P〈0.01 or P〈0.05）. There was no complication happened. Conclusion There is good recent effect of somatic symptoms and QOL in the patients with operation for GERD under endoscopy.