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目的探讨腹腔镜下以Crurasoft补片重建食管裂孔并行Nissen胃底折叠术在老年胃食管反流(GERD)中的应用效果。方法 2006年7月至2009年7月3年期间我科共收治老年(≥65岁)GERD患者22例,其中行Nissen胃底折叠术并以Crurasoft补片无张力重建食管裂孔者10例(直径≥5 cm者2例,<5 cm者8例),行Nissen胃底折叠术并以间断缝合方式重建食管裂孔者12例(直径≥5 cm者2例,<5 cm者10例)。对2组患者手术资料以及术前和术后3个月及1年的症状变化(烧心、反酸、吞咽困难、呼吸道疾患)、胃镜检查情况、食管下段压力(LESP)及24 h pH检查(DeMeester评分)结果进行对比分析。结果补片组手术时间长于缝合组(P<0.05),缝合组有2例术后发生折叠胃底移位致症状复发。两种手术方式均可改善患者症状,与术前比较其GERD症状评分明显降低(P<0.05),补片组的GERD症状评分又低于缝合组(P<0.05);缝合组术后1年其烧心及反酸症状较术后3个月有所加重(P<0.05)。2组患者术后的胃镜、LESP及pH复查情况较术前均有所改善,胃黏膜改变评分及24 h食管pH评分明显降低,LESP明显升高(P<0.05);其中补片组的改善情况优于对应时间的缝合组(P<0.05);缝合组组内术后1年时的LESP及24 h食管pH评分较术后3个月又明显降低或升高(P<0.05)。结论腹腔镜下Crurasoft补片重建食管裂孔并行Nissen胃底折叠术是治疗老年GERD的一种安全有效的方法。
Objective To investigate the effect of laparoscopic reconstruction of esophageal hiatus with Crurasoft patch in combination with Nissen fundoplication in elderly patients with gastroesophageal reflux disease (GERD). Methods Twenty-two elderly patients (≥65 years old) with GERD were enrolled in our department from July 2006 to July 2009. The patients underwent Nissen fundoproliferation and reconstruction of esophageal foramen with Crurasoft patch without tension. Ten patients (diameter 2 cases of ≥5 cm and 8 cases of <5 cm). Nissen fundoplication and interrupted suture reconstruction of esophageal perforation were performed in 12 cases (2 cases> 5 cm in diameter and 10 cases <5 cm). The surgical data and the changes of symptoms (heartburn, acid reflux, dysphagia, respiratory diseases), gastroscopy, lower esophageal pressure (LESP) and 24 h pH examination before operation and 3 months and 1 year after operation DeMeester score) results for comparative analysis. Results The operation time in the patch group was longer than that in the suture group (P <0.05). Two patients in the suture group had the recurrence of the symptoms caused by the folded fundus. Both of the two surgical methods could improve the symptoms of patients, and the GERD symptom score was significantly lower than that before operation (P <0.05). The score of GERD symptom in the patch group was lower than that in the suture group (P <0.05) The heartburn and acid reflux symptoms worse than 3 months after operation (P <0.05). Gastroscopy, LESP and pH were improved in both groups after operation compared with those before operation. Gastric mucosal changes score and esophageal pH value at 24 hours were significantly decreased and LESP was significantly increased (P <0.05). The improvement of patch group (P <0.05). The LESP and 24-h esophageal pH values at 1 year after operation in the suture group were significantly lower or higher than those at 3 months after operation (P <0.05). Conclusions Laparoscopic Crurasoft patch reconstruction of esophageal hiatus in parallel with Nissen fundoplication is a safe and effective method for the treatment of elderly patients with GERD.