胃食管反流病抗反流术后复发的再次腹腔镜手术治疗

Laparoscopic reoperation for recurred antireflux surgery of gastroesophageal reflux disease

目的探讨二次腹腔镜抗反流手术治疗食管裂孔疝修补术和（或）胃底折叠术后复发的胃食管反流病（GERD）的安全性和疗效。方法回顾性分析2008年1月至2015年9月因症状和解剖学复发在火箭军总医院胃食管反流病科行二次腹腔镜抗反流手术的连续19例GERD患者的临床资料。男性12例，女性7例，二次手术年龄（48±14）岁，距首次手术时间[M（Q。）]为30（54）个月。二次术前行钡餐造影、胃镜、食管测压和24hpH值监测。二次手术采取腹腔镜食管裂孔修补＋胃底折叠术。记录患者首次术前、二次术前和二次术后的GERD相关症状评分，记录患者术后用药、并发症及疗效满意度。手术前后数据比较采用重复测量的方差分析。结果二次手术无死亡和重大并发症，6例术后出现腹胀、排气增多、腹泻、吞咽困难和腹痛等。二次抗反流术后平均随访（33±22）个月，GERD相关症状评分均较二次术前下降（F=25．0～56．7，P=0．000—0．001），总体显效率为68％。1例在二次手术后3个月部分复发。12例患者对二次手术疗效感到满意或非常满意。结论二次腹腔镜抗反流手术治疗食管裂孔疝修补术和（或）胃底折叠术后复发的GERD效果良好，并发症可接受。

Objective To investigate the safety and effectiveness of laparoscopie reoperation for patients with gastroesophageal reflux disease （GERD） recurred form previous anti-reflux surgery. Methods Totally 19 patients received laparoscopic reoperation for symptomatic and anatomic recurred GERD in Department of Gastroesophageal Reflux Disease, Rocket Force General Hospital from January 2008 to September 2015 were retrospectively analyzed. There were 12 male and 7 female patients. The average reoperation age was （48 ± 14 ） years, the average duration of reoperation from original ones was （43± 38） months. The patients underwent preoperative barium, endoscopy, manometry and 24-hour pH studies. Laparoscopic hiatal hernia repair plus fundoplication was carried out for reoperation. Gastroesophageal reflux related symptoms （reflux, heartburn, chest pain, chough, wheezing, chest tightness and globus sensation） before and after surgery were compared by a questionnaire. The patients＇ medication consumption, complications and satisfaction of the reoperation were investigated as well. The repeated measures analysis of variance was used for statistical comparison of data preoperatively and postoperatively. Results No major complication and death occurred. Six cases （32%） had complications such as diarrhea, increased passing wind, flatulence, dysphagia and abdominal pain. The GERD related symptom score of reflux, heartburn, chest pain, chough, wheezing, chest tightness and globus sensation all significantly decreased （F： 25.0 to 56.7 ; P： 0. 000 to 0. 001 ） after the reoperation, with 68% good outcome of all the patients. After a followup of （33 ± 22） months after reoperation, 1 case had partial recurrence at the 3^nd month after reoperation. For all the patients, 12 cases felt very satisfied or satisfied with the reoperation. Conclusion Laparoscopic reoperation is generally effective with acceptable morbidity rates for patients with esophageal and extraesophageal symptoms recurred form previous hiatal repair and （or） fundoplication.