食管探条在腹腔镜Nissen胃底折叠术中的应用研究

Value research of intraoperative esophageal bougie applied in laparoscopic Nissen fundoplication

目的评估术中应用食管探条对腹腔镜Nissen胃底折叠术的疗效。方法收集中国人民解放军火箭军特色医学中心2015年3至10月收治的120例诊断明确胃食管反流病(GERD)的患者资料。将120例GERD患者随机分为探条组和对照组,各60例。对探条组患者在胃底折叠术后立即用56F食管探条进行扩张;对照组不进行探条扩张。术后1~2周、1~3个月、6个月及1年分别对2组患者进行随访。同一患者术前术后数据采用配对t检验;组间正态数据采用独立样本t检验,非正态数据采用秩和检验进行比较。计数资料采用χ^(2)检验进行比较。结果成功随访117例,3例信息获得不全。其中,探条组58例,对照组59例。2组患者手术过程顺利、无严重并发症及死亡病例。2组患者均未出现食管穿孔。2组术中出血量、手术时间及术后住院时间比较,差异均无统计学意义(P>0.05)。胃底折叠术后6个月,2组患者各症状评分均明显降低,差异均有统计学意义(P<0.05)。2组间各症状缓解率比较,差异均无统计学意义(P>0.05)。探条组吞咽困难发生率在术后1~2周、1~3个月、6个月均明显低于对照组,差异均有统计学意义(P<0.05)。术后1年,2组间吞咽困难发生率比较,差异无统计学意义(P>0.05)。探条组吞咽困难评分中位数在术后1~2周、1~3个月、6个月、1年均明显低于对照组,差异均有统计学意义(P<0.05)。2组间其他并发症发生率差异无统计学意义(P>0.05)。结论腹腔镜Nissen胃底折叠术中应用食管探条可降低术后吞咽困难发生率,且术后时间越长,差异越小;还可降低术后吞咽困难程度,提高患者的舒适度。术中应用食管探条对其他并发症发生率及临床疗效无明显差异,无食管穿孔及相关并发症,值得在临床上推广及应用。

Objective To investigate the effect of intraoperative esophageal bougie applied in laparoscopic Nissen fundoplication.Methods We collected 120 cases ofgastroesophageal reflux disease(GERD)in PLA Rocket Force Characteristic Medical Centerfrom March 2015 to October 2015 and divided them into two groups randomly,with 60 cases in bougie group and 60 cases in control group.The bougie group was dilated with a 56 F esophageal bougie after the completion of the fundoplication,while the control group did not perform the dilatation.We conducted the follow-up of both groups at 1 week,2 weeks,1 months,2 months,3 months,6 months and 1 year.The same patient’s postoperative data adopted a pair T test;the inter-component normal data employed the independent sample T test,and the non-normal data was compared by rank sum inspection.The count data was compared usingχ^(2) inspection.Results 117 cases were successfully followed up,with three missing cases.There were 58 case in bougie group and 59 in control group.The surgical procedure was successful for each patient,without serious complications and deaths during the procedure.There were no esophageal perforations in both groups.The amount of bleeding,operative time and postoperative hospital stay had nosignificant differences between two groups(P>0.05).At six months after fundoplication,the symptom score of the two groupswere significantly reduced(P<0.05).Thecorresponding symptomatic relief rateshad nosignificant difference between two groups(P>0.05).Postoperative dysphagia rates were lower in bougie group than those in the control groupat1 week,2 weeks,1 months,2 months,3 months,and 6 months(P<0.05);but postoperative dysphagia rate at 1 year had no significant difference between twogroups.The median dysphagia scores were lower in bougie group than those of in the control group at 1 week,2 weeks,1 months,2 months,3 months,6 months and 1 year(P<0.05).There was no significant difference in the incidence of other complications between 2 groups(P>0.05).Conclusion The application of intraoperativeesophageal bougie during laparoscopic Nissen fundoplication significantly reduces the rates of postoperative dysphagia,and the differences of postoperative dysphagia rates between two groups diminish with time.The application of intraoperativeesophageal bougie during laparoscopic Nissen fundoplication can significantly reduce thedegree of postoperative dysphagia,and improve the comfort of patients.The application of intraoperativeesophageal bougie during laparoscopic Nissen fundoplicationhas no significant difference on the rates of other complications andclinical outcome,and has no esophagus perforation orrelated complications,and it is deserved promotion and application in clinic.