经口内镜下贲门缩窄术治疗难治性胃食管反流病的临床疗效  

Clinical efficacy of peroral endoscopic cardial constriction for treatment of refractory gastroesophageal reflux disease

作　　者：刘礼剑[1] 黄晓燕[1] 韦金秀 杨成宁 陈广文[1] 李建锋 刘莉[1] 赵一娜[1] 卢杰夫[1] LIU Li-jian;HUANG Xiao-yan;WEI Jin-xiu;YANG Cheng-ning;CHEN Guang-wen;LI Jian-feng;LIU Li;ZHAO Yi-na;LU Jie-fu(Department of Spleen and Stomach Diseases,the First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,China)

机构地区：[1]广西中医药大学第一附属医院脾胃病科,南宁市530023

出　　处：《广西医学》2022年第8期810-814,831,共6页Guangxi Medical Journal

基　　金：国家中医药管理局中医药循证能力建设项目(2019XZZX-XH003);广西自然科学基金(2018GXNSFBA281130);广西科技计划(桂科AD19245168);广西中医药民族医药传承创新专项课题(GZZX15-02)。

摘　　要：目的观察经口内镜下贲门缩窄术(PECC)治疗难治性胃食管反流病(RGERD)的临床疗效。方法将60例RGERD患者随机分为观察组和对照组,每组30例。观察组患者采用PECC治疗,对照组患者采用Stretta射频治疗。比较两组患者术后2个月时的临床疗效,术前和术后2个月时反流情况、DeMeester计分、食管下括约肌压力(LESP)、健康调查简表(SF-36)生活质量评分、汉密尔顿焦虑量表(HAMA)评分和汉密尔顿抑郁量表(HAMD)评分,以及术后2个月、6个月、12个月时复发率。结果术后2个月时,观察组的总有效率高于对照组(P<0.05),两组患者的24 h反流次数、反流时间、pH<4反流时间百分比与DeMeester积分均低于术前,LESP均高于术前,且观察组的24 h反流次数、反流时间、pH<4反流时间百分比与DeMeester积分均低于对照组,LESP高于对照组(均P<0.05)。治疗后随着时间的延长,两组患者的SF-36评分均升高,HAMA评分与HAMD评分均降低,其中在术后2个月、6个月、12个月时,观察组的SF-36评分均高于对照组,而HAMA评分与HAMD评分均低于对照组(均P<0.05)。两组患者术后6个月、12个月时的复发率比较,差异均无统计学意义(均P>0.05)。结论PECC治疗RGERD患者总有效率较高,其可明显改善患者食管酸反流情况、LESP、焦虑抑郁状态,并提高患者生活质量。Objective To observe the clinical efficacy of peroral endoscopic cardial constriction(PECC)for the treatment of refractory gastroesophageal reflux disease(RGERD).Methods Sixty patients with RGERD were randomly divided into observation group and control group,with 30 cases in each group.Patients in the observation group received PECC therapy,whereas patients in the control group received Stretta radiofrequency therapy.Multiple indices were compared between the two groups,including clinical efficacy on patients two months after the operation,the condition of reflux,DeMeester scores,lower esophageal sphincter pressure(LESP),the MOS 36-Item Short-Form Health Survey(SF-36)scores for quality of life,the Hamilton Anxiety Scale(HAMA)scores and the Hamilton Depression Scale(HAMD)scores before the operation and two months after the operation,as well as the recurrence rates two,six and 12 months after the operation.Results Two months after the operation,the total effective rate of the observation group was higher than that of the control group(P<0.05),the frequency of reflux over 24 hours,duration of reflux,percentage of duration of reflux with pH<4,and DeMeester score were decreased,and LESP was higher in both groups as compared with those before the operation;moreover,the observation group had declines in frequency of reflux over 24 hours,duration of reflux,percentage of duration of reflux with pH<4,and DeMeester score,and higher LESP as compared with the control group(all P<0.05).SF-36 scores increased and HAMA and HAMD scores decreased over time in both groups after the treatment,and two,six and 12 months after the operation,the observation group exhibited higher SF-36 scores and lower HAMA and HAMD scores than the control group(all P<0.05).There was no statistically significant difference in the recurrence rate between the two groups six and 12 months after the operation(all P>0.05).Conclusion PECC has a relatively high total effective rate for treating patients with RGERD,which can significantly ameliorate patients′

关 键 词：难治性胃食管反流病 经内镜下贲门缩窄术 Stretta射频治疗 食管下括约肌压力 疗效 复发 

分 类 号：R655.4[医药卫生—外科学]