胃镜下腔内折叠术治疗胃食管反流病

Endoluminal gasrtroplication for gastroesophageal reflux disease

目的 探讨治疗胃食管反流病（GERD）的新方法——胃镜下腔内折叠术（ELGP）的操作方法、适应证及禁忌症等问题。方法 选择无服药情况下出现每周3次以上烧心或反酸、食物反流,并且24 h食管pH监测证实胃酸异常者,共26例进行ELGP,其中2例为贲门切除术后的胃食管反流病患者。26例 GERD患者食管下端裂口直径1.5～3.5cm,平均 2.5cm;并食管裂孔疝20例,达77％。缝合器为美国BARD公司二代缝合器。术前检查、常规胃镜观察后,辅助静脉麻醉,在齿状线下或吻合口下1～3cm缝合,采用环行、纵行或两种方法结合治疗。记录手术前后食管裂口大小、缝合位置、针间距、缝合皱褶数、术中不良反应等。结果 共缝合32例次,其中环行缝合17例次,纵行缝合11例次,环行和纵行结合缝合4例次。两针间距1～3cm,两褶间距约1.5～2cm。每例次1～4个褶,平均每例2.3个褶。缝合后食管裂口平均约1.5 cm。烧心及反流症状改善总有效率76％（完全缓解36％,部分缓解40％）,无效24％。1例感冒患者术中出现呼吸困难,余无严重并发症。结论胃镜下腔内折叠术能明显改善胃食管反流病的症状,2cm以上的食管裂孔疵及贲门切除术后胃食管反流均可应用该方法进行治疗,术程安全。

Objective The transoral endoluminal gasrtroplication (ELGP) is a new endoscopic therapy in gastroesophageal reflux disease (GERD) . We studied this procedure on its safety, indications, contraindications and the primary efficacy. Methods Routine endoscopic examination followed ELGP was performed in 26 patients with GERD, including 2 patients with resection of cardiac orifice. These patients suffered from 3 times or more episodes of heartburn or regurgitation per week while withdrew any medication, and the acid reflux was verified by 24-hour pH monitoring. The ELGP was performed with a linear pattern in 8 patients, circumferential in 14 cases and the combination of both patterns in 4 patients. The esophageal hiatus was 1.5 - 3. 5 cm in diameter, with average of 2. 5 cm in 26 patinets, and 20 patients were identifed to suffer from hiatus hernia. The suturing device was available of the BARD Suturing System II. Results The plicae were within 3 cm from the squamocolumnar junction or gastroesophageal stoma, sutured on the lesser curve with linear configuration in 11 patients, around the cardiac orifice with circumferential configuration in 17 cases and with the combination of both configurations in 4 patients. The distance was 1 - 3 cm between two stitchs and 1.5 - 2 cm between two folds. Thirty - two procedures were finished in 26 patiensts with a total of 60 plicae, second procedure was required in 6 patients. Each patient was sutured for 1 - 4 plicae with an average of 2. 3 plicae. The heartburn and regurgitation were improved in 76% of patients, resolved completely in 36% and remitted partly in 40%. Dyspnoea happened in one patient during operation as having suffered from cold, and the others were free of serious complications. Conclusions The symptoms of GERD can be significantly improved by ELGP which are applicable to GERD with 3 times or more episodes of heartburn or regurgitation per week,or the reflux from resection of cardiac orifice. This procedure generally is effective, convenient and safe,but it is not indicated in patients with acute cold, serious pulmonary or heart diseases.