腹腔镜下应用球囊胃管治疗胃食管反流病的疗效研究  

The effectiveness of laparoscopy combined with balloon tube for the treatment of gastroesophageal reflux disease

作　　者：杨凯[1] 刘昶[1] 纪艳超[1] 姜龙[1] 崔磊[1] 

机构地区：[1]哈尔滨医科大学附属第四医院,黑龙江哈尔滨150001

出　　处：《腹腔镜外科杂志》2014年第10期742-745,共4页Journal of Laparoscopic Surgery

摘　　要：目的：探讨应用腹腔镜并以球囊胃管限制胃底折叠程度治疗胃食管反流病（gastroesophageal reflux disease,GERD）的疗效。方法：分析2011年2月至2013年4月应用腹腔镜治疗的21例GERD患者的临床资料。术中均应用球囊胃管并行Nissen式胃底折叠术,其中9例伴食管裂孔疝患者在完成疝修补后行此术式。结果：21例患者均成功完成腹腔镜手术,术中出血量15-30 ml,平均（18.0±3.5）ml;手术时间35-193 min,平均（108±19）min;术后住院3-9 d,平均（4.8±1.5）d。术后未发生严重并发症,术后随访8-18个月,平均（12.0±4.5）个月。1例患者于术后3个月复发;术后6个月,余20例患者再次行24 h食管pH值测定及胃镜复查,其中pH值监测DeMeester评分较术前明显降低,差异有统计学意义（P〈0.05）;复查胃镜患者中,2例术前胃镜分级为Ⅰ级的患者未发生明显变化,3例从Ⅲ级恢复至Ⅰ级,余15例患者表现正常。结论：应用腹腔镜并以球囊胃管限制胃底折叠程度治疗GERD疗效确切,具有创伤小、康复快、安全等优点。Objective： To explore the efficacy of balloon tube combined with laparoscopy for limiting fundoplication degree in the treatment of gastroesophageal reflux disease（ GERD）. Methods： The clinical data of 21 patients with GERD who underwent laparoscopy during Feb. 2011 and Apr. 2013 were analyzed. All the patients received fundoplication（ Nissen） and balloon tube. Among the cases,fundoplication was carried out in all,and fundoplication combined with laparoscopic hiatal herniorrhaphy was performed on 9 patients. Results： The procedures were completed successfully in all the cases. The patients had blood loss ranged from 15 to 30 ml with a mean of（ 18. 0 ± 3. 5） ml. The operation time ranged from 35 to 193 min with a mean of（ 108 ± 19） min. They were discharged from the hospital in 3 to 9 d with a mean of（ 4. 8 ± 1. 5） d after the surgery. There were not severe postoperative complications. Patients were followed up for 8-18 months,the average was（ 12. 0 ± 4. 5） months. One patient showed recurrent esophageal hiatal hernia in three months after the operation. 20 patients received re-examination by 24-h esophageal pH and gastroscopy in six months after the operation. The DeMeester score reduced significantly,the differences had statistical significance（ P〈 0. 05）. Normal results of gastroscopy were found in 15 cases,three cases showed improvement（ from grade Ⅲ to grade Ⅰ）,and no improvement in two cases（ grade Ⅰ）.Conclusions： The effectiveness of balloon tube combined with laparoscopy limiting fundoplication degree for the treatment of GERD is ideal,the treatment has advantages of minimal invasion,quick recovery and high safety.

关 键 词：胃食管反流 球囊胃管 胃底折叠术 腹腔镜检查 

分 类 号：R571[医药卫生—消化系统]