顽固性复杂胃食管反流病的多术式腹腔镜抗反流手术治疗研究

Therapeutic effects and safety of laparoscopic anti reflux surgery on intractable complex gastroesophageal reflux disease

目的探讨在顽固性复杂胃食管反流病(GERD)治疗中,腹腔镜抗反流手术(LARS)的治疗安全性和有效性。方法自2012年1月至2016年12月年行手术治疗的GERD患者中选取顽固性复杂GERD患者30例,患者病史均>3年就诊经历复杂,并且多次误诊为其他疾病,其中术前误诊为冠心病13位,误诊为慢性咳嗽6例,误诊为哮喘3例,另外吴诊为慢性咽炎8例,对症治疗疗效不佳。就诊于胃食管反流门诊后确诊GERD,其中17位患者合并食道裂孔疝。给予PPI加强治疗,全部患者不适症状,均有不同程度缓解,最大缓解率90%,最低缓解50%,但无法停药。行LARS手术治疗,术后随访症状缓解、用药及手术并发症等指标。结果行Nissen、Toupet、DOR胃底折叠术分别为18例、10例和2例,围术期并发症发生率为3.33%。平均随访时间(24.27±1.57)月,对患者术前术后生活质量进行测评,术后各项症状评分均较术前有显著改善。手术治疗效果满意率为86.67%。3例患者术后并发慢性吞咽困难,1例复发,复发率为3.33%。结论顽固性GERD合并食道外症状或者无明显反流患者临床诊断难度大,易误诊,病史多较长,药物保守治疗效果有限或无法停药。通过运用LARS手术治疗顽固性复杂GERD,疗效确切,安全可行,可根据患者的临床特征合理选择术式。

Objective To explore the safety and efficacy of laparoscopic anti reflux surgery(LARS)in the treatment of intractable complex gastroesophageal reflux disease(GERD).Methods Thirty patients with refractory complex GERD who were treated by surgery in our hospital from January 2012 to December 2016 were enrolled in the study.These patients were treated by PPI and LARS(Nissen,Toupet and DOR fundoplication),with follow up after operation for average(24.27±1.57)months.And the clinical symptoms,medication status and postoperative complications were observed.Results The perioperative incidence rate of complications was 10%.The scores of survial quality after operation were significantly improved.The satisfactory rate of operation effects was 86.67%.Three patients suffered from chronic dysphagia after operation,and one patient had relapse,with relapse rate being 3.33%.Conclusion LARS is safe and effective in treating intractable complex GERD,and it is necessary to select the operation mode according to the clinical characteristics of patients.