氩离子凝固术联合腹腔镜食管裂孔疝修补术加胃底折叠术治疗食管裂孔疝合并Barrett食管的疗效观察

Clinical study of argon plasma coagulation combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia with Barrett esophagus

目的探讨氩离子凝固术（APC）联合腹腔镜食管裂孔疝修补术加胃底折叠术治疗食管裂孔疝合并Barrett食管的临床效果。方法前瞻性纳入新疆维吾尔自治区人民医院微创外科、疝和腹壁外科2010年6月至2014年1月期间收治的61例食管裂孔疝合并Barrett食管患者．通过计算机随机编码分为两组：29例患者予以APC术后再给予埃索美拉唑40mg．1次／d．持续8周（APC联合药物组）；32例患者予以APC术后再行腹腔镜食管裂孔疝修补术联合Nissen胃底折叠术（APC联合手术组）。两组分别于术后半年和1年进行随访并复查胃镜，对比两组患者Barrett食管改善与复发的差异。结果APC联合药物组患者经过1～2次APC治疗后Barrett食管消除．半年后复查胃镜，病理结果示7例Barrett食管复发，1年后复查累计16例（16／29，55．2％）复发：APC联合手术组患者手术后半年复查胃镜，病理结果示1例Barrett食管复发，1年后复查累计2例（2／32，6．3％）复发；APC联合手术组复发率明显低于APC联合药物组（P〈0．01）。随访过程中，除APC联合手术组1年后1例食管裂孔疝复发外，全组未发生癌变病例。结论对于食管裂孔疝同时合并Barrett食管者，APC术后再行腹腔镜食管裂孔疝修补术加胃底折叠术效果良好。

Objective To investigate the clinical efficacy of argon plasma coagulation （APC） combined with laparoscopic hiatal hernia repair and fundoplication in the treatment of hiatal hernia associated with Ban＇ett esophagus. Methods A total of 61 cases of hiatal hernias with Barrett esophagus from June 2010 to January 2014 in the Depamnent of Minimal Invasive Surgery, Hernia and Abdominal wall Surgery, People＇s Hospital of Xinjiang Uyhur Autonomous Region were prospectively enrolled and were randomly allocated into two groups by computer system. Twenty-nine patients received esomeprazole 40 mg/d after APC treatment for 8 weeks （APC with medicine group）. Thirty-two patients underwent laparoscopic hiatal hernia repair and Nissen fundoplication after APC treatment （APC with surgery group）. All the patients were reviewed by gastroscope and pathologic examination at half a year and one year after operation respectively. Differences of disease improvement and recurrence between the two groups were evaluated. Results In APC with medicine group, the Barrett＇s esophagus was relieved after one or two times of APC treatment, however, gastroscope and pathology revealed recurrence of Barrett＇s esophagus in 7 cases at half a year, and cumulative 16 cases of recurrences were detected after one year follow-up （16/29, 55.2%）. In APC with surgery group, only one patient had recurrent Barrett＇s esophagus at half a year, and a total of two at one year follow-up by gastroscope examination（2/32, 6.3%）. Significantly low recurrence rate of Barrett＇s esophagus was observed in APC with surgery group compared to APC with medicine group（P〈0.01 ）. Furthermore, recurrent hiatal hernia was detected in only one case in APC with surgery group. No esophageal cancer was found in both groups during follow-up. Conclusion APC combined with laparoscopic hiatal hernia repair and fundoplication is an ideal method for patients with hiatal hernia and Barrett＇s esophagus.