内镜下胃食管阀瓣套扎术对难治性反流性食管炎的临床研究

Clinical study of endoscopic gastroesophageal valve ligation for refractory reflux esophagitis

目的探讨内镜下胃食管阀瓣套扎术在难治性反流性食管炎中的应用效果及安全性。方法选取2019年5月至2021年5月宜春市人民医院收治的44例难治性反流性食管炎患者作为研究对象,采用随机数字表法分为对照组(22例)和观察组(22例)。对照组予以常规药物治疗,观察组予以内镜下胃食管阀瓣套扎术治疗,均随访6个月。比较两组患者的胃食管反流健康相关生命质量问卷(GERD-HRQL)评分、胃食管反流症状诊断问卷(GERDQ)评分、食管炎分级、阀瓣Hill分级、症状控制满意度、质子泵抑制剂使用情况及不良反应发生情况。结果两组患者治疗前的GERD-HRQL评分及GERDQ评分比较,差异无统计学意义(P>0.05);两组患者治疗后的GERD-HRQL评分及GERDQ评分均低于治疗前,差异有统计学意义(P<0.05);观察组治疗后的GERD-HRQL评分及GERDQ评分低于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的食管炎分级比较,差异无统计学意义(P>0.05);两组患者治疗后的食管炎分级优于治疗前,差异有统计学意义(P<0.05);观察组治疗后的食管炎分级优于对照组,差异有统计学意义(P<0.05)。两组患者治疗前的阀瓣Hill分级比较,差异无统计学意义(P>0.05);观察组治疗后的阀瓣Hill分级优于治疗前,且观察组治疗后的阀瓣Hill分级优于对照组,差异有统计学意义(P<0.05)。观察组的症状控制总满意度高于对照组,差异有统计学意义(P<0.05)。观察组的质子泵抑制剂使用情况优于对照组,差异有统计学意义(P<0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论内镜下胃食管阀瓣套扎术治疗难治性反流性食管炎的效果确切,能有效降低GERD-HRQL评分、GERDQ评分,改善食管炎及阀瓣Hill分级,加快反流症状消失,减轻疾病对日常生活的影响,安全可靠。

Objective To investigate the efficacy and safety of endoscopic gastroesophageal valve ligation for refractory reflux esophagitis.Methods A total of 44 patients with refractory reflux esophagitis admitted to Yichun People's Hospital from May 2019 to May 2021 were selected as the research objects,and they were divided into the control group(22 cases)and the observation group(22 cases)according to random number table method.The control group was treated with conventional medicine,and the observation group was treated with endoscopic gastroesophageal valve ligation.All patients were followed up for 6 months.The health related quality of life questionnaire for gastroesophageal reflux disease(GERD-HRQL)score,gastroesophageal reflux disease questionnaire(GERDQ)score,esophagitis grading,valve Hill grading,the total satisfaction degree of symptom control,proton pump inhibitor use and the incidence of adverse reactions were compared between the two groups.Results There were no significant differences in the GERD-HRQL score and GERDQ score between the two groups before treatment(P>0.05).After treatment,the GERD-HRQL score and GERDQ score in the two groups were lower than those before treatment,the differences were statistically significant(P<0.05).The GERD-HRQL score and GERDQ score of the observation group were lower than those of the control group after treatment,and the differences were statistically significant(P<0.05).The grade of esophagitis in the observation group was better than that in the control group,and the difference was statistically significant(P<0.05).The Hill grading of valve disc in the observation group was better than that in the control group,and the difference was statistically significant(P<0.05).The total satisfaction degree of symptom control in the observation group was higher than that in the control group,the difference was statistically significant(P<0.05).The usage of proton pump inhibitors in the observation group was better than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Endoscopic gastroesophageal valve ligation is effective in the treatment of refractory reflux esophagitis,which can effectively reduce GERD-HRQL score and GERDQ score,improve esophagitis and valve Hill grade,speed up the symptoms of reflux,reduce the impact of the disease on daily life,and it is safe and reliable.