内镜下抗反流黏膜切除术治疗质子泵依赖性胃食管反流病的短期疗效观察

Short term effects of anti-reflux mucosectomy for proton pump inhibitor dependent gastroesophageal reflux disease

2017年7月-2020年12月间, 在南京鼓楼医院行内镜下抗反流黏膜切除术(anti-reflux mucosectomy, ARMS)治疗的26例质子泵抑制剂依赖性胃食管反流病连续病例纳入回顾性分析, 主要比较手术前后的反流症状评分(GERD-Q评分)、生活质量评分(RQS评分)、食管动力及24 h测酸检查结果。结果发现:中位随访18.4个月(6~27个月), 23例(88.5%)临床症状得到明显缓解, 15例(57.7%)停用质子泵抑制剂, 平均GERD-Q评分(6.23分比13.19分, P=0.004)和平均RQS评分(26.67分比10.98分, P<0.001)均较术前明显好转, 平均DeMeester评分(10.69分比53.15分, P<0.001)、平均酸反流时间百分比(3.56%比9.92%, P<0.001)、平均酸反流总次数(36.9次比139.9次, P=0.001)均明显低于术前, 平均食管下括约肌静息压(25.19 mmHg比13.63 mmHg, P<0.001)和平均远端收缩积分(1 819.15 mmHg·s·cm比1 007.67 mmHg·s·cm, P<0.001)均较术前明显增加。提示ARMS治疗质子泵抑制剂依赖性胃食管反流病短期疗效显著, 可有效改善患者的反流症状和生活质量, 增加患者的食管下括约肌静息压和食管体部蠕动。

Clinical data of 26 patients with proton pump inhibitor dependent gastroesophageal reflux disease(GERD)who underwent anti-reflux mucosectomy(ARMS)in Nanjing Drum Tower Hospital from July 2017 to December 2020 were reviewed,and the GERD questionnaire(GERD-Q)score,the short-form reflux-qual(RQS)score,esophageal motility and 24 h esophageal pH parameters before and after ARMS were compared.With a median follow-up period of 18.4 months(6-27 months),23(88.5%)patients reported symptomatic improvement and 15(57.7%)patients discontinued the use of proton pump inhibitors.After ARMS,the mean scores of GERD-Q(6.23 VS 13.19,P=0.004)and RQS(26.67 VS 10.98,P<0.001)were significantly improved,the mean DeMeester score(10.69 VS 53.15,P<0.001),the mean acid exposure time percentage(3.56%VS 9.92%,P<0.001)and the mean number of acid reflux episodes(36.9 VS 139.9,P=0.001)were lower,and the mean rest pressure at lower esophageal sphincter(LES)(25.19 mmHg VS 13.63 mmHg,P<0.001)and the mean distal contractile integral(1819.15 mmHg·s·cm VS 1007.67 mmHg·s·cm,P<0.001)were significantly increased compared with those before surgery.ARMS has significant short-term efficacy in the treatment of proton pump inhibitor dependent GERD,which can effectively improve reflux symptoms and life quality of patients,and strengthen the rest pressure of LES and peristalsis of the esophageal body.