腹腔镜胃底折叠术治疗胃食管反流病相关性咳嗽70例

Laparoscopic fundoplication for gastroesophageal reflux disease-related cough： a report of 70 cases

目的观察腹腔镜胃底折叠术治疗胃食管反流病（GERD）相关性咳嗽的疗效与安全性。方法回顾性分析2008年6月至2013年6月间解放军第二炮兵总医院胃食管反流病科连续收治并接受腹腔镜胃底折叠术治疗的70例GERD相关性咳嗽患者的临床资料。比较患者手术前后食管反流相关症状（反流、烧心、咳嗽、咳痰、咽部异物感和声音嘶哑）评分，计算各症状的评分缓解率[（术前症状评分一术后症状评分）／术前症状评分x100％]，观察患者术后并发症的发生情况及对手术治疗的满意程度。结果患者术后食管反流相关症状评分均较术前显著下降（均P〈0．01），上述各症状的评分缓解率分别为反流（79．4±23．2）％，烧心（82．0±21．5）％，咳嗽（72．2±28．5）％，咳痰（62．6±28．9）％，咽部异物感（76．1±31．5）％，声音嘶哑（70．8±39．3）％。全组无死亡病例，且患者术中、术后均未出现严重并发症，但出现气腹相关的胸部或颈部皮下气肿5例（7．1％）、术后早期和晚期不同程度吞咽困难17例（24．3％），术后排气增多6例（8．6％），腹胀2例（2．9％），经治疗后均可缓解。全组患者手术满意率（满意和非常满意）为75．7％（53／70）。结论腹腔镜胃底折叠术治疗GERD相关性咳嗽安全有效且具有较高的患者满意度。

Objective To investigate the efficacy and safety of laparoscopic fundoplication for gastroesophageal reflux disease （GERD）-related cough. Methods Retrospective review of 70 patients with GERD-related cough who received laparoscopic fundoplication in GERD Department of The Second Artillery General Hospital during June 2008 to June 2013 was carried out. GERD-related symptoms （reflux, heartburn, cough, expectoration, globus sensation and hoarseness） before and after surgery were compared through questionnaire, and the symptom remission rate （preoperative symptom score - postoperative symptom score ） /preoperative symptom score x100% ） was calculated. Complication morbidity and satisfaction degree of patients were investigated. Results The GERD-related symptom scores of regurgitation, heartburn, cough, expectoration, globus sensation and hoarseness all significantly decreased （all P 〈0.01） after the anti-reflux laparoscopic fundoplication, with the corresponding symptom remission rates as （79.4±23.2）%, （82.0±21.5）%, （72.2±28.5）%, （62.6± 28.9）%, （76.1±31.5）% and （70.8±39.3）% respectively. No major complication and death occurred.Five cases （7.1%） had pneumoperitoneum-related chest or neck subcutaneous emphysema, 17 cases （24.3%） had various degree of early and late dysphagia, 6 cases （8.6%） had increased flatus and 2 cases had bloating after surgery. All the complications could be cured by appropriate treatment. Among all the patients, 16 cases （15.7%） felt very satisfied, 37 cases （52.9%） felt satisfied, 11 cases （15.7%） felt acceptable, 4 cases （5.7%） felt unsatisfied and 2 cases felt very unsatisfied with the surgery. Conclusion Laparoscopic fundoplication is safe and effective for GERD-related cough, with quite high satisfaction degree form patients.