术中食管测压指导腹腔镜Nissen胃底折叠术  

Intraoperative Manometry in Laparoscopic Nissen Fundoplication: Report of 35 Cases

作　　者：余江洪[1] 于磊[2] 于涛[2] 伍冀湘 Yu Jianghong;Yu Lei;Yu Tao(Department of General Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院普外科,北京100730 [2]首都医科大学附属北京同仁医院胸外科,北京100730

出　　处：《中国微创外科杂志》2018年第8期721-723,727,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市科学技术委员会首都临床特色基金(z141107002514121);北京市医管局临床医学发展专项(杨帆计划)重点医学专业发展计划项目"微创消化外科"(ZYLX201612)

摘　　要：目的探讨术中食管测压指导胃底折叠术的临床价值。方法回顾性分析2012年5月～2017年6月35例腹腔镜治疗胃食管反流病(gastroesophageal reflux disease,GERD)的临床资料,术中应用高分辨率食管测压,根据测压值调整胃底折叠程度至压力达20～35 mm Hg,分析术前、术后GERD Q评分和测酸、测压结果。结果手术均获成功,10例根据术中测压结果进行折叠改变。手术时间50～100 min,平均70 min。术后住院3～7 d,平均4 d。无中转开腹,无严重并发症。术后随访6～60个月,平均28个月,无吞咽困难和反酸。与术前相比,术后6个月24 h内最长反流时间缩短[(22.4±8.3)min vs.(2.1±1.0)min,t=14.712,P=0.000],持续反流>5 min次数减少[(4.3±1.8)次vs.(0.4±0.5)次,t=12.811,P=0.000],GERD Q评分降低[(12.2±2.1)分vs.(5.3±1.6)分,t=8.226,P=0.023],食管下括约肌压力升高[(10.3±2.3)mm Hg vs.(26.8±2.5)mm Hg,t=-31.711,P=0.000]。结论对于腹腔镜胃底折叠术,基于术中食管测压值可以进行折叠襻的调整,减少并发症,保证术后治疗效果。Objective To explore the clinical value of intraoperative manometry in directing the laparoscopic Nissen fundoplication for gastroesophageal reflux diseases（ GERD）. Methods The clinical data of 35 patients who underwent laparoscopic surgery for GERD from May 2012 to June 2017 were analyzed retrospectively. Intraoperative high resolution manometry were used in directing the Nissen fundoplication. We adjusted the fundus folding based on the values of the intraoperative manometry until 20-35 mm Hg. The GERD questionnaire（ GERD Q） score,pre-and postoperative manometry,and 24-hour p H results were analyzed.Results All the operations were successful and there were a total of 10 cases of alterations of the fundoplication performed according to the values of the intraoperative manometry. The operation time was 50-100 min（ mean,70 min）. The postoperative hospital stay was3-7 d（ mean,4 d）. There was no case converted to open operation and no serious complications. The patients were followed up for 6-60 months（ mean,28 months）. There was no dysphagia or acid reflux occurred postoperatively. At 6 months after operation,the24-h reflux time was shorter [（ 22. 4 ± 8. 3） min vs.（ 2. 1 ± 1. 0） min,t = 14. 712,P = 0. 000],the reflux times was less [（ 4. 3 ±1. 8） times vs.（ 0. 4 ± 0. 5） times,t = 12. 811,P = 0. 000],the GERD Q score was lower [（ 12. 2 ± 2. 1） points vs.（ 5. 3 ± 1. 6）points,t = 8. 226,P = 0. 023],and the lower esophageal sphincter pressure was higher [（ 10. 3 ± 2. 3） mm Hg vs.（ 26. 8 ± 2. 5）mm Hg,t =-31. 711,P = 0. 000] than before operation. Conclusions Intraoperative manometry is a useful tool for laparoscopic fundoplication and can be used to adjust the folding. It is proved to reduce the complications and improve the clinical outcomes.

关 键 词：胃食管反流病 术中测压 胃底折叠术 

分 类 号：R656[医药卫生—外科学]