腹腔镜抗反流手术治疗胃食管反流病对慢性阻塞性肺部疾病的影响

Diagnosis and treatment of chronic obstructive pulmonary disease associated with gastroesophageal reflux disease

目的观察腹腔镜抗反流手术治疗胃食管反流病(GERD)对慢性阻塞性肺部疾病(COPD)的影响。方法收集2016年1月至2017年12月期间在郑州大学第一附属医院住院且采用腹腔镜抗反流手术治疗的20例GERD合并COPD患者,对所有患者采用反流诊断量表、肺功能、肺功能评估测试量表、24 h食管pH-阻抗监测和食管压力测定并对其结果作相关性分析。所有患者经保守治疗无效后选择腹腔镜下抗反流手术,12个月后完成随访,并再次对治疗前、后COPD和GERD相关参数结果进行对比,评价治疗效果。结果本组20例GERD患者均成功实施腹腔镜手术,无疝补片修补患者,无死亡病例,所有患者未发生食管破裂、出血、感染等术后严重并发症。术后8例患者出现不同程度的吞咽困难和10例出现不同程度的腹胀,均自行缓解。对20例GERD合并COPD患者在术后随访1年,无一例失访。与治疗前比较,治疗后患者的GERD症状评分、反流次数、DeMeester评分、COPD评估测试量表评分均明显降低(P<0.05),下食管括约肌压力、第1秒用力呼气容积(FEV1)占预计值百分率和FEV1/用力肺活量(FVC)均明显升高(P<0.05)。按照全球创议慢性阻塞性肺病分级标准,8例痊愈患者中5例Ⅰ级、2例Ⅱ级、1例Ⅲ级,9例改善患者中1例Ⅰ级、4例Ⅱ级、4例Ⅲ级,3例无效患者中1例Ⅰ级、1例Ⅱ级、1例Ⅳ级,总有效率85%(17/20)。结论 COPD与GERD密切相关,腹腔镜抗反流术的治疗不仅能治疗GERD,还可以明显改善COPD。

Objective To evaluate laparoscopic anti-reflux surgery for treatment of chronic obstructive pulmonary disease(COPD) associated with gastroesophageal reflux disease(GERD). Methods A total of 20 patients with GERD and COPD underwent laparoscopic anti-reflux procedure in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2017. The reflux diagnostic questionnaire,pulmonary function,COPD assessment test scale,24-hour esophageal pH-impedance monitoring and esophageal pressure measurement were performed in all patients. All drug-refractory patients underwent the laparoscopic anti-reflux surgery. After 12 months follow-up,the parameters of COPD and GERD were evaluated again. Results Twenty patients with COPD and GERD were successfully performed laparoscopic anti-reflux surgery,no hernia patch repair patient and death patient occurred. There was no esophageal rupture,bleeding,infection,and other serious postoperative complications. Although 8 patients had the different degree dysphagia and 10 patients had the different degree abdominal distention,they all relieved themselves.Twenty patients with GERD and COPD were followed up for 1 year. Compared with the values before treatment,the GERD symptom score,reflux times,DeMeester score,and COPD assessment test score of the patients were significantly reduced(P<0.05),the lower esophageal sphincter pressure,percentage of forced expiratory volume in one second(FEV1)in the predicted value and FEV1/forced vital capacity(FVC) were significantly increased(P<0.05) after the treatment.According to the grading standard of The Global Initiative for Chronic Obstructive Lung Disease(GOLD),5 cases of grade Ⅰ,2 cases of grade Ⅱ and 1 case of grade Ⅲ were cured;1 case of grade Ⅰ,4 cases of grade Ⅱ and 4 cases of gradeⅢ were improved;1 case of grade Ⅰ,1 case of grade Ⅱ and 1 case of grade Ⅳ were ineffective. The total effective rate was85%(17/20). Conclusions COPD is closely related to GERD. Laparoscopic anti-reflux surgery can not only effectively treat GERD,but also markedly improve COPD.