腹腔镜Dor胃底折叠联合His角重建术治疗胃食管反流病的短期疗效观察

Short-term efficacy of laparoscopic Dor fundoplication combined with the reconstruction of His angle in the treatment of gastroesophageal reflux disease

目的探讨腹腔镜Dor胃底折叠术联合His角重建治疗胃食管反流病(gastroesophageal reflux disease,GERD)的短期效果。方法回顾性分析2019年1月至2020年12月在首都医科大学宣武医院普通外科接受腹腔镜Dor胃底折叠+His角重建术(Dor+His角重建组,41例)或单纯Dor胃底折叠术(Dor组,45例)治疗的GERD患者的临床资料,比较两组患者手术前后的食管症状及食管外症状评分、功能性并发症、患者满意度情况。结果两组术前食管症状及食管外症状评分差异无显著性(P>0.05);术后6个月时两组患者的食管症状及食管外症状评分均明显低于术前,且Dor+His角重建组反流症状评分低于Dor组,差异有显著性(P<0.05),而两组其他症状评分比较差异无显著性(P>0.05)。两组术后功能性并发症(包括吞咽困难、腹胀、难以嗳气、排气增多及慢性腹部疼痛)发生率差异无显著性(P>0.05),经保守治疗均获得明显缓解。Dor+His角重建组患者对手术治疗的满意度为92.7%(38/41),与Dor组的91.1%(41/45)比较差异无显著性(P>0.05)。结论Dor胃底折叠+His角重建术与Dor胃底折叠术治疗GERD均有较好的抗反流效果,手术并发症少,患者满意度高,且Dor胃底折叠+His角重建术控制反流症状的效果更佳。

Objective To investigate the efficacy of Dor fundoplication combined with the reconstruction of His angle for gastroesophageal reflux disease(GERD).Method The clinical data of GERD patients who received Dor fundoplication combined with His angle reconstruction or Dor fundoplicaton alone in the department of general surgery of Xuanwu Hospital of Capital Medical University from January 2019 to December 2020 were retrospectively analyzed,and the differences of the efficacy and the satisfaction of the two procedures were observed.Result Eighty six GERD patients were included in this study,including 41 patients in the Dor+His angle reconstruction group and 45 patients in the Dor group.After 6 months postoperatively,GERD symptoms(esophageal symptoms:reflux,heartburn,chest and back pain,and distension in the lower of xiphoid;extraespphageal symptoms:cough,wheezing,foreign body sensation of pharynx)scores were significantly lower,compared with those before treatment(all P<0.05).In postoperative symptoms scores,score of the reflux symptom of the Dor+His angle reconstruction group was lower than that of Dor group,the difference was statistically significant(Z=-2.193,P=0.028).And there were no statistical difference in the scores of other symptom between the two groups(all P>0.05).The satisfaction of the group of Dor+His angle reconstruction and the group of Dor was 92.7%(38/41)and 91.1%(41/45),respectively,and no significant difference was observed(P=0.790).Postoperative functional complications(including dysphagia,abdominal distention,difficult belching,increased exhaust and chronic abdominal pain)were similar in both groups,and were significantly relieved by conservative treatment.Conclusion The both of two procedures had good anti-reflux efficacy,with few and mild surgical complications and high patient satisfaction.Compared to Dor group,Dor+His angle reconstruction group had better control of reflux symptom,which required prospective,large-sample,and long-term follow-up results to confirm.