腹腔鏡下以Crurasoft重建食管裂孔在老年GERD患者中的應用研究_《中國普外基礎與臨床雜志》

作者：

費陽 , 李基業

解放軍總醫院第一附屬醫院普通外科（北京 100048）;

關鍵詞：

胃食管反流腹腔鏡胃底折疊術食管裂孔疝

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的探討腹腔鏡下以Crurasoft補片重建食管裂孔并行Nissen胃底折疊術在老年胃食管反流（GERD）中的應用效果。方法2006年7月至2009年7月3年期間我科共收治老年（≥65歲）GERD患者22例，其中行Nissen胃底折疊術并以Crurasoft補片無張力重建食管裂孔者10例(直徑≥5 cm者2例， lt;5 cm者8例），行Nissen胃底折疊術并以間斷縫合方式重建食管裂孔者12例(直徑≥5 cm者2例， lt;5 cm者10例）。對2組患者手術資料以及術前和術后3個月及1年的癥狀變化（燒心、反酸、吞咽困難、呼吸道疾患）、胃鏡檢查情況、食管下段壓力（LESP）及24 h pH檢查（DeMeester評分）結果進行對比分析。結果補片組手術時間長于縫合組（P lt;0.05），縫合組有2例術后發生折疊胃底移位致癥狀復發。兩種手術方式均可改善患者癥狀，與術前比較其GERD癥狀評分明顯降低（P lt;0.05），補片組的GERD癥狀評分又低于縫合組（P lt;0.05）；縫合組術后1年其燒心及反酸癥狀較術后3個月有所加重（P lt;0.05）。 2組患者術后的胃鏡、LESP及pH復查情況較術前均有所改善，胃黏膜改變評分及24 h食管pH評分明顯降低，LESP明顯升高（P lt;0.05）；其中補片組的改善情況優于對應時間的縫合組（P lt;0.05）；縫合組組內術后1年時的LESP及24 h食管pH評分較術后3個月又明顯降低或升高（P lt;0.05）。結論腹腔鏡下Crurasoft補片重建食管裂孔并行Nissen胃底折疊術是治療老年GERD的一種安全有效的方法。

引用本文： 費陽,李基業. 腹腔鏡下以Crurasoft重建食管裂孔在老年GERD患者中的應用研究. 中國普外基礎與臨床雜志, 2011, 18(8): 866-870. doi: 復制

1.	Locke GR 3rd, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux:a populationbased study in olmsted county, Minnesota [J]. Gastroenterology, 1997, 112(5): 14481456.
2.	MoraesFilho JP, Chinzon D, Eisig JN, et al. Prevalence of heartburn and gastroesophageal reflux disease in the urban brazilian population [J]. Arq Gastroenterol, 2005, 42(2): 122127.
3.	汪忠鎬，陳秀，韓冰，等．胃食管反流病引起“頑固性哮喘”以致氣胸一例報告 [J]．臨床誤診誤治， 2006， 19（11）： 89．.
4.	Lafullarde T, Watson DI, Jamieson GG, et al. Laparoscopic Nissen fundoplication: fiveyear results and beyond [J]. Arch Surg, 2001, 136(2): 180184.
5.	Bammer T, Hinder RA, Klaus A, et al. Fiveto eightyear outcome of the first laparoscopic nissen fundoplications [J]. J Gastrointest Surg, 2001, 5(1): 4248.
6.	Frantzides CT, Madan AK, Carlson MA, et al. A prospective, randomized trial of laparoscopic polytetrafluoroethylene(PTFE)patch repair vs simple cruroplasty for large hiatal hernia [J]. Arch Surg, 2002, 137(6): 649652.
7.	崔莉紅，朱風珍，陳桂敏，等．老年人胃食管反流病食道壓力測定和24小時pH監測的臨床特點 [J]．中國老年學雜志， 2009， 29（17）： 22462247．.
8.	Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: clinical applications [J]. JAMA, 2002, 287(15): 19821986.
9.	Hazzard WR. Demographic peristalsis. implications of the age wave for gastroenterologists [J]. Gastroenterol Clin North Am, 2001, 30(2): 297311, vii.
10.	汪忠鎬，吳繼敏，劉建軍，等．并發嚴重肺毀損的胃食管喉氣管綜合癥一例糾誤挽治 [J]．臨床誤診誤治， 2007， 20（9）： 12．.
11.	Collen MJ, Abdulian JD, Chen YK. Gastroesophageal refluxdisease in the elderly: more severe disease that requires aggressive therapy [J]. Am J Gastroenterol, 1995, 90(7): 10531057.
12.	Tutuian R, Vela MF, Shay SS, et al. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring [J]. J Clin Gastroenterol, 2003, 37(3): 206215.
13.	Patti MG, Arcerito M, Tamburini A, et al. Effect of laparoscopic fundoplication on gastroesophageal reflux diseaseinduced respiratory symptoms [J]. J Gastrointest Surg, 2000, 4(2): 143149.
14.	Tobin RW, Pope CE, Pellegrini CA, et al. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis [J]. Am J Respir Crit Care Med, 1998, 158(6): 18041808.
15.	Terry M, Smith CD, Branum GD, et al. Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia [J]. Surg Endosc, 2001, 15(7): 691699.
16.	Granderath FA, Kamolz T, Schweiger UM, et al. Quality of life, surgical outcome, and patient satisfaction three years after laparoscopic nissen fundoplication [J]. World J Surg, 2002, 26(10): 12341238.
17.	Horgan S, Pohl D, Bogetti D, et al. Failed antireflux surgery: what have we learned from reoperations? [J]. Arch Surg, 1999, 134(8): 809815.
18.	Khajanchee YS, Urbach DR, Butler N, et al. Laparoscopic antireflux surgery in the elderly [J]. Surg Endosc, 2002, 16(1): 2530.
19.	Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation herniation: preliminary results of a prospective randomized functional and clinical study [J]. Arch Surg, 2005, 140(1): 4048.
20.	Carlson MA, Condon RE, Ludwig KA, et al. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair [J]. J Am Coll Surg, 1998, 187(3): 227230.

1. Locke GR 3rd, Talley NJ, Fett SL, et al. Prevalence and clinical spectrum of gastroesophageal reflux:a populationbased study in olmsted county, Minnesota [J]. Gastroenterology, 1997, 112(5): 14481456.
2. MoraesFilho JP, Chinzon D, Eisig JN, et al. Prevalence of heartburn and gastroesophageal reflux disease in the urban brazilian population [J]. Arq Gastroenterol, 2005, 42(2): 122127.
3. 汪忠鎬，陳秀，韓冰，等．胃食管反流病引起“頑固性哮喘”以致氣胸一例報告 [J]．臨床誤診誤治， 2006， 19（11）： 89．.
4. Lafullarde T, Watson DI, Jamieson GG, et al. Laparoscopic Nissen fundoplication: fiveyear results and beyond [J]. Arch Surg, 2001, 136(2): 180184.
5. Bammer T, Hinder RA, Klaus A, et al. Fiveto eightyear outcome of the first laparoscopic nissen fundoplications [J]. J Gastrointest Surg, 2001, 5(1): 4248.
6. Frantzides CT, Madan AK, Carlson MA, et al. A prospective, randomized trial of laparoscopic polytetrafluoroethylene(PTFE)patch repair vs simple cruroplasty for large hiatal hernia [J]. Arch Surg, 2002, 137(6): 649652.
7. 崔莉紅，朱風珍，陳桂敏，等．老年人胃食管反流病食道壓力測定和24小時pH監測的臨床特點 [J]．中國老年學雜志， 2009， 29（17）： 22462247．.
8. Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett esophagus, and esophageal cancer: clinical applications [J]. JAMA, 2002, 287(15): 19821986.
9. Hazzard WR. Demographic peristalsis. implications of the age wave for gastroenterologists [J]. Gastroenterol Clin North Am, 2001, 30(2): 297311, vii.
10. 汪忠鎬，吳繼敏，劉建軍，等．并發嚴重肺毀損的胃食管喉氣管綜合癥一例糾誤挽治 [J]．臨床誤診誤治， 2007， 20（9）： 12．.
11. Collen MJ, Abdulian JD, Chen YK. Gastroesophageal refluxdisease in the elderly: more severe disease that requires aggressive therapy [J]. Am J Gastroenterol, 1995, 90(7): 10531057.
12. Tutuian R, Vela MF, Shay SS, et al. Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring [J]. J Clin Gastroenterol, 2003, 37(3): 206215.
13. Patti MG, Arcerito M, Tamburini A, et al. Effect of laparoscopic fundoplication on gastroesophageal reflux diseaseinduced respiratory symptoms [J]. J Gastrointest Surg, 2000, 4(2): 143149.
14. Tobin RW, Pope CE, Pellegrini CA, et al. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis [J]. Am J Respir Crit Care Med, 1998, 158(6): 18041808.
15. Terry M, Smith CD, Branum GD, et al. Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia [J]. Surg Endosc, 2001, 15(7): 691699.
16. Granderath FA, Kamolz T, Schweiger UM, et al. Quality of life, surgical outcome, and patient satisfaction three years after laparoscopic nissen fundoplication [J]. World J Surg, 2002, 26(10): 12341238.
17. Horgan S, Pohl D, Bogetti D, et al. Failed antireflux surgery: what have we learned from reoperations? [J]. Arch Surg, 1999, 134(8): 809815.
18. Khajanchee YS, Urbach DR, Butler N, et al. Laparoscopic antireflux surgery in the elderly [J]. Surg Endosc, 2002, 16(1): 2530.
19. Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation herniation: preliminary results of a prospective randomized functional and clinical study [J]. Arch Surg, 2005, 140(1): 4048.
20. Carlson MA, Condon RE, Ludwig KA, et al. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair [J]. J Am Coll Surg, 1998, 187(3): 227230.

《中國普外基礎與臨床雜志》

腹腔鏡下以Crurasoft重建食管裂孔在老年GERD患者中的應用研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國普外基礎與臨床雜志》

腹腔鏡下以Crurasoft重建食管裂孔在老年GERD患者中的應用研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料