折叠术治疗胃食管反流病.docVIP

经胃镜腔内折叠术治疗胃食管反流病 经胃镜腔内折叠术治疗胃食管反流病的临床研究[摘要] 目的 探讨治疗胃食管反流病（GERD）的新方法——经胃镜腔内折叠术（ELGP）的操作方法、治疗效果、适应证及禁忌症等问题。方法 选择无服药情况下出现每周3次以上烧心或胃酸、食物反流，并且24h食管pH监测证实胃酸异常者26例进行ELGP, 其中2例为贲门切除术后的胃食管反流病患者。缝合器为美国BARD公司二代缝合器。术前检查、常规胃镜观察后，辅助静脉麻醉，在齿状线下或吻合口下1-3cm缝合，采用环行、纵行或两种方法结合治疗。记录手术前后食管裂口大小、缝合位置、针间距、缝合皱褶数、术中不良反应等。结果 26例GERD患者食管下端裂口直径1.5-3.5cm，平均2.6cm；并食管裂孔疝20例，达77%。共缝合32例次，其中环行缝合17例次，纵行缝合11例次，纵行和环行结合缝合4例次。两针间距1-3cm，两褶间距约1.5-2cm。每例次1-4个褶，平均每例2.3个褶、每例次1.88个皱褶。缝合后食管裂口平均约1.5cm。烧心及反流症状改善总有效率76%（完全缓解36%，部分缓解40%），无效24%。1例感冒患者术中出现呼吸困难，余无严重并发症。结论 胃镜下环行、纵行或环行纵行结合缝合均能明显改善胃食管反流病的症状，2cm以上的食管裂孔疝及贲门切除术后胃食管反流均可应用该方法进行治疗，术程安全。[关键词] 胃食管反流病；经胃镜腔内折叠术Clinical utility of endoluminal gasrtroplication in gastroesophageal reflux disease.Yang Yunsheng, Linghua Enqiang, Sun Gang, Wang Xiangdong, Meng Jiangyun, Guo Rongbin, Wang Zhiqiang, Cheng Liufang and Wang HongzhiDepartment of Gastroenterology, Chinese PLA General Hospital, Beijing 100853,China.Abstract Objective The transoral endoluminal gasrtroplication (ELGP) is a new endoscopic therapy in gastroesophageal reflux disease (GERD) and appealing. We studied the treatment for its procedures, safety, indications, contraindications and the primary efficacy. Methods 26 patients with GERD were performed by routin endoscopic examination followed ELGP, including 2 patients with resection of cardiac orifice. These patients suffered from 3 or more heartburn or regurgitation episodes per week while taking no medicine, and the acid reflux was verified by 24-hour pH monitoring. The ELGP was performed with a linear pattern in 8 patients, circumferential in 14 cases and the combination of both patterns in 4 patients. The suturing device was available of the BARD Suturing SystemⅡ. Results The esophageal hiatus was 1.5-3.5cm of diameter, with average of 2.5cm in 26 patinets, and 20 patients were identifed to suffer from hiatus hernia. The plicae were within 3cm from the squamocolumnar junction or gastroesophageal stoma, sutured on the lesser curve with linear configurat