Effect of medical and surgical treatment of Barrett's metaplasia

Barrett’s esophagus (BE) is a change in the esophageal mucosa as a result of long-standing gastroesophageal reflux disease. The importance of BE is that it is the main risk factor for the development of esophageal adenocarcinoma, whose incidence is currently growing faster than any other cancer in the Western world. The aim of this review was to compare the common treatment modalities of BE, with the focus on proton pump inhibitors and operative fundoplication. We performed a literature search on medical and surgical treatment of BE to determine eligible studies for this review. Studies on medical and surgical treatment of BE are discussed with regard to treatment effect on progression and regression of disease. Although there is some evidence for control of reflux with either medical or surgical therapy, there is no def initive evidence that either treatment modality decreases the risk of progression to dysplasia or cancer. Even though there is a trend toward antireflux surgery being superior, there are no def initive studies to prove this.

腹腔镜Nissen's胃底折叠术治疗小儿胃食管反流性疾病

目的 介绍腹腔镜Nissen’s胃底折叠术治疗小儿胃食管反流性疾病。方法 总结上海儿童医学中心 2001年 10月～2003年 2月、芝加哥大学儿童医院 2001年 7月～2002年 7月腹腔镜Nissen’s 胃底折叠术治疗小儿胃食管反流性疾病50例。患儿年龄1个月～17岁(平均年龄3.7岁)。结果 49例镜下完成Nissen’s术,平均手术时间93.8min(57～211 min)。术后平均1.3 d进食(1～4d),术后平均住院天数4.5 d(2～31 d),平均随访6.1个月(1～12个月),无胃食管反流复发。1例术中因开始经验和技术不足中转开腹。结论 腹腔镜Nissen’s胃底折叠术是治疗小儿胃食管反流性疾病有效的微创手术。具有术后疼痛轻、恢复快、并发症少等优点。

环形缝扎加胃底折叠术预防晚期血吸虫病病人术后再出血效果

目的评估食管下段梯状环形缝扎黏膜下血管及胃底折叠术对晚期血吸虫病(晚血)门脉高压症并发上消化道出血的治疗效果。方法 2006-2011年选择患晚血门脉高压症患者,随机分为联合手术治疗组(联合组)与单纯手术治疗组(单纯组)。单纯组患者行门奇静脉断流术,联合组在此基础上加行食管下段梯状环形缝扎黏膜下血管及胃底折叠术。术后通过胃镜检查随访,比较2种术式的治疗效果。结果共选择晚血患者158例,联合治疗组75例,单纯治疗组83例。术后两组治疗有效率分别为81.3%(61/75)和30.1%(25/83)(χ2=39.44,P<0.01),发生再出血率分别为2.7%(2/75)和12.0%(10/83)(χ2=24.36,P<0.01),两组差异有统计学意义。结论食管下段梯状环形缝扎黏膜下血管及胃底折叠术对预防术后再出血效果明显,且术式安全,可作为治疗晚血门脉高压症的常规手术方式。