腹腔镜胃底折叠术治疗质子泵抑制剂依赖性胃食管反流病10年疗效:单中心160例报道
Effect of laparoscopic fundoplication for proton pump inhibitor dependent gastroesophageal reflux disease:a 10-year follow-up report of 160 cases in a single center
胡志伟 1吴继敏 1李萌 1刘健男 1邓昌荣 1战秀岚 1纪涛 1王峰 1田书瑞 1张玉 1陈冬1
作者信息
- 1. 中国人民解放军火箭军特色医学中心胃食管外科,北京 100088
- 折叠
摘要
目的 探讨腹腔镜胃底折叠术治疗质子泵抑制剂(PPI)依赖性胃食管反流病(GERD)的长期疗效.方法 回顾性分析2012年1至6月于中国人民解放军火箭军特色医学中心接受腹腔镜胃底折叠术的PP1依赖性GERD患者的临床资料.研究指标包括GERD症状评分、症状主观缓解率、PPI停药率和手术满意度,以及复发和并发症等.结果 本研究共纳入GERD患者160例,其中64％的患者合并呼吸道症状,行Nissen和Toupet胃底折叠术分别为43和117例,平均随访时间为(127±3)个月.患者术后各GERD相关症状评分均显著低于治疗前(均P＜0.001);消化道和呼吸道总体症状主观缓解程度分别为90％(80％,100％)和100％,PPI停药率为86％,疗效总满意率为92％,其中合并呼吸道症状患者的满意率为89％.7％患者出现不同程度的症状复发,4％的患者再次接受内镜下治疗和(或)腹腔镜胃底折叠术,6/7患者再次取得满意疗效.术后长期吞咽困难、腹胀、嗳气、排气增多、腹痛、腹泻和便秘发生率分别为 11.3％、16.9％、0、1.3％、0、2.5％和5.6％.结论 腹腔镜胃底折叠术治疗GERD具有良好的长期疗效,少数患者术后可出现复发以及吞咽困难和腹胀等并发症,复发患者可通过内镜下治疗或二次手术重新取得满意疗效.
Abstract
Objective To explore the long-term efficacy of laparoscopic fundoplication for proton pump inhibitor dependent gastroesophageal reflux disease(GERD).Method Clinical data of proton pump inhibitor dependent GERD patients who underwent fundoplication at the Rocket Force Characteristic Medical Center from Jan to Jun 2012 were analyzed,including GERD symptom score,subjective symptom relief rate,PPI discontinuation rate and surgical satisfaction,as well as recurrence and complications.Result A total of 160 GERD patients were included in this study,with 64％of patients having respiratory symptoms.Nissen and Toupet fundoplication were performed in 43 and 117 cases,respectively,with a follow-up time of(127±3)months.The postoperative GERD symptom scores of the patients were significantly lower than before treatment(all P＜0.001);The subjective relief of overall symptoms in the digestive tract and airway problem was 90％(80％,100％)and 100％,respectively.The PPI discontinuation rate was 86％,and the overall satisfaction rate of the treatment was 92％,and the satisfaction rate of patients with respiratory symptoms was 89％.7％of patients experienced varying degrees of symptomatic recurrence,4％of patients re-underwent endoscopic treatment and/or laparoscopic fundoplication due to symptom recurrence.The incidence of long-term postoperative dysphagia,bloating,belching,increased exhaust,abdominal pain,diarrhea,and constipation were 11.3％,16.9％,0,1.3％,0,2.5％,and 5.6％,respectively.Conclusions Laparoscopic fundoplication has good long-term efficacy in the treatment of GERD.A small number of patients may experience postoperative recurrence,as well as complications such as dysphagia and gas-bloat syndrome.Most recurrent patients can achieve good therapeutic effect by redoing endoscopic treatment or redoing surgery.
关键词
胃食管反流/胃底折叠术/质子泵抑制剂/疝,食管裂孔/食管炎,消化性Key words
Gastroesophageal reflux/Fundoplication/Proton pump inhibitors/Hernia,hiatal/Esophagitis,peptic引用本文复制引用
出版年
2024
NETL
NSTL
万方数据