腹腔镜胃底食管左侧半折叠术治疗胃食管反流病的临床疗效

Clinical efficacy of laparoscopic left hemi‑fundoplication for gastroesophageal reflux disease

    摘要
  • 摘要:
    探讨腹腔镜胃底食管左侧半折叠术治疗胃食管反流病（GERD）的临床疗效。
    采用回顾性描述性研究方法。收集2019年7月至2022年7月河北省中医院收治的45例GERD患者的临床资料；男26例,女19例；年龄为（46±12）岁。患者均行腹腔镜胃底食管左侧半折叠术。观察指标：（1）手术及术后情况。（2）随访情况。正态分布的计量资料以x±s表示。计数资料以绝对数表示。手术前后指标比较采用配对样本t检验。
    （1）手术及术后情况。45例患者均顺利完成手术,无中转开放手术或术中并发症发生,手术时间为（86±8）min,术中出血量为（12±3） mL,术后首次肛门排气时间为（2.2±0.8）d。45例患者中,术后发热4例、胸骨后隐痛不适3例、术后吞咽困难4例、腹胀3例、便秘5例,均经对症治疗后痊愈或自行缓解。患者术后住院时间为（3.5±0.5）d。无感染、迟发性出血及穿孔患者。（2）随访情况。45例患者均获得术后1年随访,无GERD复发。胃镜未见食管黏膜破损如糜烂、溃疡,未发生食管裂孔疝。术前反流症状指数评分、GERD问卷评分、反流性疾病诊断问卷评分、食管下括约肌压力、24 h食管pH值连续监测DeMeester评分分别为（24.3±1.9）分、（12.5±2.1）分、（20.1±4.5）分、（7.1±1.1）mmHg（1 mmHg=0.133 kPa）、（31.4±6.4）分,术后1年上述指标分别为（2.2±0.7）分、（6.5±0.5）分、（4.0±2.6）分、（23.2±2.9）mmHg、（6.0±1.4）分,手术前后比较,差异均有统计学意义（t=80.75,18.70,20.09,-33.45,26.15,P<0.05）。
    腹腔镜胃底食管左侧半折叠术治疗GERD安全、可行,可改善患者临床症状。

     

    Abstract:
    Objective To explore the clinical efficacy of laparoscopic left hemi-fundoplica-tion for gastroesophageal reflux disease (GERD).
    Method The retrospective and descriptive study was conducted. The clinical data of 45 patients with GERD who were admitted to Hebei Provincial Hospital of Traditional Chinese Medicine from July 2019 to July 2022 were collected. There were 26 males and 19 females, aged (46±12) years. All patients underwent laparoscopic left hemi‑fundoplication. Observation indicators: (1) intraoperative and postoperative conditions; (2) follow‑up. Measurement data with normal distribution were expressed as Mean±SD. Count data were expressed as absolute numbers. The paired samples t‑test was used for comparison of indicators before and after surgery.
    Result (1) Intraoperative and postoperative conditions. All 45 patients successfully underwent the operation, with no conversion to open surgery or intraoperative complications. The operation time was (86±8)minutes, volume of intraoperative blood loss was (12±3)mL, and time to postoperative first flatus was (2.2±0.8)days. Among the 45 patients after surgery, 4 cases had fever, 3 cases had retrosternal dull pain and discomfort, 4 cases had dysphagia, 3 cases had abdominal distension, and 5 cases had constipation. All these symptoms were cured or relieved spontaneously after sympto-matic treatment. The duration of postoperative hospital stay was (3.5±0.5)days. There was no patient with infection, delayed bleeding or perforation.(2) Follow‑up. All 45 patients were followed up for 1 year after surgery, with no recurrence of GERD. Gastroscopy showed no esophageal mucosal damage such as erosion or ulcer, and no hiatal hernia occurred. Before surgery, the reflux symptom index score, GERD questionnaire score, reflux disease questionnaire score, lower esophageal sphincter resting pressure, and DeMeester score of 24‑hour esophageal pH monitoring were 24.3±1.9, 12.5±2.1,20.1±4.5, (7.1±1.1)mmHg (1 mmHg=0.133 kPa), and 31.4±6.4, respectively. At 1 year after surgery, the above indicators were 2.2±0.7, 6.5±0.5, 4.0±2.6, (23.2±2.9)mmHg, and 6.0±1.4, respectively. There were significant differences before and after surgery (t=80.75, 18.70,20.09, -33.45, 26.15, P<0.05).
    Conclusion Laparoscopic left hemi‑fundoplication is safe and feasible for GERD, which can improve the clinical symptoms of patients.

     

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