ARMS治疗难治性胃食管反流病的疗效及对围术期指标的影响

Anti-reflux mucosal resection for treatment of refractory gastro-oesophageal reflux disease:Efficacy and impact on perioperative indicators

背景难治性胃食管反流病(refractory gastroesophageal reflux disease,RGERD)具有治疗难度大、易反复发作等特点,对于此类患者,抗反流黏膜切除术(anti reflux mucosal resection,ARMS)是临床治疗RGERD的主要术式,但其具体优劣仍有待明确.目的探讨ARMS治疗RGERD的疗效及对围术期指标的影响.方法选取2019-01/2021-12期间102例RGERD患者,按照随机数字表法分组,各51例.对照组给予腹腔镜Nissen胃底折叠术,观察组给予ARMS治疗.比较两组手术情况、术后恢复情况、手术前后GerdQ评分、食管外症状评分、高分辨率食管测压参数[腹段食管下括约肌(lower esophageal sphincter,LES)长度、LES静息压(lower esophageal sphincter resting pressure,LESP)、食管上括约肌静息压(upper esophageal sphincter resting pressure,UESP)、远端收缩积分(distal contractile integral,DCI)]、24 h pH-阻抗监测指标[DeMeester评分、酸反流、弱酸反流、液体反流、气体反流、混合反流次数]、胃动力学指标[血清胃动素(motilin,MTL)、胃泌素(gastrin,GAS)]水平及并发症.结果观察组手术时间短于对照组(P<0.05),术中失血量少于对照组(P<0.05);两组住院时间差异无统计学意义;两组术后1 mo、6 mo GerdQ评分、食管外症状评分较术前下降(P<0.05),且观察组低于对照组(P<0.05);术后1 mo、6 mo两组腹段LES长度长于术前(P<0.05),且观察组长于对照组(P<0.05),LESP、UESP、DCI高于术前(P<0.05),且观察组高于对照组(P<0.05);两组术后1 mo、6 mo DeMeester评分、酸反流、弱酸反流、液体反流、气体反流、混合反流次数低于术前,观察组低于对照组(P<0.05);术后1 mo、6 mo两组血清MTL、GAS较术前升高,观察组高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05).结论ARMS治疗RGERD能显著优化手术情况,促进临床症状消退,改善食管动力学与胃动力学,减少胃反流事件,还能降低并发症发生率.

BACKGROUND Refractory gastroesophageal reflux disease(RGERD)is difficult to treat and recurrent.For such patients,anti-reflux mucosal resection(ARMS)is the main clinical treatment,but its advantages and disadvantages remain unclear.AIM To investigate the efficacy of endoscopic ARMS in the treatment of RGERD and its impact on perioperative indicators.METHODS A total of 102 patients with RGERD were selected from January 2019 to December 2021 and divided into either a control group or an observation group using the random number table method,with 51 cases in each group.The control group underwent laparoscopic Nissen fundoplication,and the observation group underwent ARMS treatment.The operation conditions,postoperative recovery,GerdQ score before and after surgery,extraesophageal symptom score,high-resolution esophageal manometry parameters[abdominal lower esophageal sphincter(LES)length,LES resting pressure(LESP),upper esophageal sphincter resting pressure(UESP),and distal systolic integral(DCI)],24 h pH-impedance monitoring indexes(DeMeester score and the number of episodes of acid reflux,weak acid reflux,fluid reflux,gas reflux,and mixed reflux),gastric dynamics indicators[serum motilin(MTL)and gastrin(GAS)],and complications were compared between the two groups.RESULTS In the observation group,the operation time was shorter than that of the control group(P<0.05),and the intraoperative blood loss was less than that of the control group(P<0.05),but the difference in hospitalization time between the two groups was not statistically significant(P>0.05).The GerdQ score and extraesophageal symptom score decreased in both groups at 1 and 6 months after surgery compared with those before surgery(P<0.05),and these scores were lower in the observation group than in the control group(P<0.05).At 1 and 6 months after surgery,the length of the LES in the abdominal segment was longer in both groups than that before surgery(P<0.05),and longer in the observation group than in the control group(P<0.05),while LESP,UESP,and DCI were higher than those before surgery(P<0.05),and higher in the observation group than in the control group(P<0.05).DeMeester score and the number of episodes of acid reflux,weak acid reflux,liquid reflux,gas reflux,and mixed reflux were lower in both groups at 1 and 6 months after surgery compared with those before surgery,and lower in the observation group than in the control group(P<0.05).Serum MTL and GAS were higher in the two groups at 1 and 6 months after surgery than those before surgery,and were higher in the observation group than in the control group(P<0.05).The incidence of complications was lower in the observation group than in the control group(P<0.05).CONCLUSION ARMS for treatment of RGERD can significantly optimize the surgical situation,promote clinical symptom regression,improve esophageal and gastric dynamics,reduce gastric reflux events,and reduce the incidence of complications.