经口内镜缝合治疗胃食管反流病的临床研究

Transoral endoscopic suturing for gastroesophageal reflux diseases

目的 评估经口内镜缝合治疗胃食管反流病 (GERD)近期疗效及并发症。 方法 对经胃镜、上消化道X线钡餐、食管PH检测等确诊的GERD 1 6例在电子胃镜下采用美国BARD缝合器缝合胃食管部 ,缝合部位选择齿状线下 1cm ,2针间距 1 5cm ,2结间距 2 0cm。比较术前及术后 1月症状积分、食管 2 4hpH变化、食管炎程度变化。 结果 1 6例共缝合 4 2针 ,2 1个结 ;平均手术时间 30min。术前烧心总积分 39,平均 2 4 4 ;反流总积分 32 ,平均 2 0。术后烧心总积分 1 1 ,平均 0 6 8;反流总积分 1 0 ,平均 0 6 3。烧心及反流术前术后比较差别均有显著性 (χ2 =1 9 5 ,1 6 33;P <0 0 0 5 )。术后 1月病人酸反流次数、最长酸反流时间、pH <4 0时间百分比均较术前明显减少 (P <0 0 0 1 )。术后 1月食管炎程度明显好转 (χ2 =2 5 78,P <0 0 0 5 )。本组总有效率 93 8% (1 5 / 1 6 ) ,完全缓解 6 2 5 % (1 0 / 1 6 ) ,部分缓解 31 3% (5 / 1 6 ) ,无效 6 3% (1 / 1 6 )。并发症主要有 :出血 ,胸骨后疼痛。 结论 经口内镜缝合治疗胃食管反流病近期疗效肯定 ,并发症少。

Objective To evaluate the short-term effects and complications of transoral endoscopic suturing in the treatment of gastroesophageal reflux diseases (GERD). Methods Sixteen patients with GERD, confirmed by gastroscopy, upper gastrointestinal barium meal examination, and esophageal pH value examination, received gastroesophageal suturing by using an endoscopic suturing device (manufactured by Bard Co.). The site of suturing was 1cm below the dentation line, with a suture interval of 1.5cm and a knot interval of 2.0cm. Symptom severity scoring, esophageal 24-hour pH monitoring and the degree of esophagitis before and 1 month after the operation were compared respectively. Results A total of 42 sutures and 21 knots were made in the 16 cases. The mean operation time was 30 min. The sum of heartburn scores and regurgitation scores before the treatment were 39 (mean, 2.44) and 32 (mean, 2.0), and those after the treatment were 11 (mean, 0.68) and 10 (mean, 0.63), respectively, with statistical significances between preoperation and postoperation ( χ 2 =19.5 and 16.33; P <0.005). The number of times of acid reflux, the longest time of acid reflux and the time percentage with pH < 4.0 at the first postoperative month were significantly less than those in preoperation ( P <0.001). Degrees of esophagitis remarkably improved 1 month after the operation ( χ 2=25.78; P <0.005). The total effective rate in the study was 93.8% (15 of 16), with a complete remission rate of 62.5% (10 of 16), a partial remission rate of 31.3% (5 of 16), and an inefficiency rate of 6.3% (1 of 16). Major complications included bleeding and substernal pain. Conclusions Transoral endoscopic suturing for GERD shows a definite short-term effect and a low incidence of complications.