Barrett食管的抗反流手术治疗:是否加行胃底成形术?  

Antireflux surgery for Barrett's esophagus:should an elongation gastroplasty be added?

作　　者：时辉[1] 牛中喜[2] Andre Duranceau 陈龙奇[1] 

机构地区：[1]四川大学华西医院胸外科,四川成都610041 [2]中国人民解放军武警总医院胸外科,北京市100853 [3]加拿大蒙特利尔大学医学中心

出　　处：《食管外科电子杂志》2013年第3期99-107,共9页Journal of Esophageal Surgery(Electronic Version)

摘　　要：目的 应用Collis-Nissen手术代替标准的Nissen胃底折叠术治疗Barrett食管的反流性疾病迄今存在争议.本文的研究目的在于比较Nissen手术与Collis-Nissen手术治疗Barrett食管的结果.方法 1976～1989年间,33例内镜确诊的Barrett食管(男:女=26:7,中位年龄48.8岁)接受了Nissen手术.随后的1990～1999年间,51例Barrett食管患者(男:女=41:10,中位年龄53.2岁)进行了Collis-Nissen手术.对两组患者术前术后的临床症状、食管钡餐、食管放射性核素排空、食管测压、24小时pH监测及胃镜检查结果进行了比较研究.结果 全组无手术死亡.Nissen组与Collis组的中位随访时间分别为8.0年与6.5年.手术后反流症状Nissen组较Collis组多见(52% vs 7%,P<0.001),且相应的24小时pH监测到的食管酸暴露时间比例也以前者为高(3.4% vs 1.0%,P=0.003).胃镜检查发现Nissen组患者食管糜烂与溃疡发生率为39%,而在Collis组为7%(P=0.007).Nissen组与Collis组的5年手术成功率分别为83%和100%,10年手术成功率分别为63%与90%(Log-rank检验,P=0.004).结论 加行胃底成形术较标准Nissen可更好地控制Barrett食管患者的胃食管反流,且降低了Nissen胃底折叠术的失败风险.Objective Using a Collis-Nissen repair instead of a standard Nissen fundoplication to treat the reflux disease of Barrett's esophagus is controversial. This paper compares the Nissen and Collis-Nissen operations when treating Barrett's esophagus. Methods Thirty-three patients with documented Barrett's esophagus(male : female=26 : 7, median age=48.8 years) had a Nissen fundoplication during 1976-1989. Fifty-one patients(male : female=41:10, median age=53.2 years) underwent a Collis-Nissen operation between 1990 and 1999. Clinical as- sessments, esophagogram, radionuclide emptying, manometry, 24 h pH study, and endoscopy were obtained pre- and postoperatively. Results There was no operative death in either group. Median follow-up was 8.0 years for the Nissen group and 6.5 years for the Collis group. Postoperative reflux symptoms were more frequent in the Nis- sen group(52%) when compared to the Collis group(7%, P< 0.001). These symptoms correlated with the 24 h pH recordings revealing an increased acid exposure in the Nissen group(3.4%) as opposed to 1% in the Collis group(P= 0.003). Endoscopy revealed mucosal erosions and ulcers in 39% of patients receiving a standard Nissen repair while these damages were seen in 7% of patients who were offered an elongation gastroplasty with a total fundopli- cation(P= 0.007). The cumulative success rate was 83% for the Nissen group and 100% for the Collis group at 5 years, and 63% versus 90% at 10 years(Log-rank test, P= 0.004). Conclusion The Collis-Nissen fundoplica- tion provides better reflux protection for Barrett's patients than a standard Nissen repair. It lowers the risk of fun- doplication failure.

关 键 词：抗反流手术 BARRETT食管 胃底折叠术 胃食管反流 胃底成形术 

分 类 号：R655.4[医药卫生—外科学]