腹腔镜胃底折叠术治疗伴有精神症状的胃食管反流性疾病  

Laparoscopic Fundoplication for gastroesophageal reflux disease with psychiatric disorders.

作　　者：杨慧琪[1] 秦明放[1] 

机构地区：[1]天津南开医院天津市微创中心,300100

出　　处：《中国实用外科杂志》2005年第10期614-616,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨伴随的精神症状是否会影响腹腔镜胃底折叠术的效果,手术是否能够改善伴随的精神症状。方法回顾性分析2001年6月至2004年7月收治的51例腹腔镜胃底折叠术后胃食管反流性疾病的临床资料。结果无精神症状组症状评分由9.50±3.07降到1.87±1.64(P=0.000),生活质量评分(G IQLI)由122.63±3.16提高到139.25±1.98(P=0.000);有精神症状组症状评分由11.63±3.46降到9.25±2.12(P=0.023),G IQLI评分由103.63±5.29提高到107.75±5.18(P=0.016),均不如无精神症状组改善显著,而且G IQLI评分中反映精神因素的评分改善无显著性(P=0.104)。无精神症状组93%对手术效果满意,而有精神症状组仅为25%。无精神症状组与有精神症状组食道下段压力和24h pH值监测评分的改善程度与手术前比差异均有显著性,并达到正常范围。无手术并发症,无中转开腹及死亡病例。结论伴随的精神症状影响手术对主观症状的改善,但不影响客观指标的改善;手术可改善疾病相关症状,但对精神症状无明显改善。对伴有非常严重的精神症状的病人,手术应持谨慎态度。Objective To establish whether concomitant psychiatric disorders might affect the outcomes of antireflux surgery. Methods Retrospectively 51 cases of Laparoscopic Fundoplication were reviewed from June 2001 to July 2004. Resuits Patients without psychiatric disorders showed improvement in the symptom score from 9. 50 ± 3.07 to 1.87 ± 1.64 （ P=0.000） ,GIQLI score from 122.63±3.16 to 139.25±1.98（P=0.000） ,whereas patients with psychiatric disorders demonstrated less improvement, symptom score from 11.63±3.46 to 9.25±2.12（ P=0.023 ）, GIQLI score from 103.63±5.29 to 107.75±5.18 （ P=0.016 ） and no significant improvement in psychiatric symptom score （P=0.104）. 93% of patients without psychiatric disorders were satisfied with surgery,as compared to 25% of patients with psychiatric disorders. The esophageal manometry and the DeMeester score of 24h pH of the patients with and without psychiatric disorders achieved the normal value. There was no postoperative complications. There was no conversion and death. Conclusion The concomitant psychiatric disorders affect the subjective symptomatic relief, but not influence the improvement of objective results. LF can relieve the disease associate symptom, not relieve the psychiatric disorders. Operations should be cautious for patients with sever psychiatric disorders.

关 键 词：胃食管反流性疾病 精神症状 腹腔镜 胃底折叠术 

分 类 号：R5[医药卫生—内科学]