目的 评估内镜下微量射频技术治疗胃食管反流病的安全性,从改善胃食管反流病相关症状、提高患者生活质量、用药情况、食管炎分级等多方面探讨微量射频技术治疗胃食管反流病临床效果.方法 对2007年6月至2010年3月接受微量射频治疗的90例胃食管反流病患者进行6～32个月的随访研究,选择观察患者治疗前、治疗后6个月、治疗后12个月时的胃食管反流症状积分(GERD-HRQL)、症状控制满意度、药物使用情况、食管炎程度.结果 微量射频治疗后患者胃食管反流症状发作明显减轻,63例(70.0%)2个月内明显减轻,15例(16.7%)在2～6个月内减轻,8例(8.9%)6个月以后明显减轻,4例(4.4%)未显示改变.GERD-HRQL积分由治疗前的(25.6±9.0),降至(7.3±4.1)(治疗后6个月,P＜0.01)和(8.1±3.9)(治疗后12个月,P＜0.01);烧心积分由治疗前的(3.3±1.3),降至(1.2±1.1)(P＜0.05);治疗前仅31.1%的患者对药物控制症状的程度感到满意,而微量射频治疗后,86.7%的患者对症状的控制感到满意;治疗后12个月,患者满意度积分由治疗前的1.4升至4.0(P＜0.01).射频治疗前,100.0%的患者需要使用PPI控制症状,其中有67.8%的患者需要PPI与2种或2种以上的其他药物合用,治疗后6个月,69例(76.7%)的患者不需服用PPI,或仅按需服用抗酸药或少量H2受体拮抗剂.术前41例有明确食管炎的患者,术后6个月,33例患者(80.5%)已无炎症改变,8例(19.5%)患者仍为A级轻度炎症.结论 微量射频治疗技术可以显著改善胃食管反流症状,提高患者对治疗的满意度,显著减少PPI的用量,减轻食管炎的程度.该项技术具有操作简单、微创、安全、有效、副作用少、恢复快等特点,易被患者接受.微量射频治疗技术为难治性胃食管反流病患者提供了一种新的内镜下微创治疗方法.%Objective To evaluate the safety and efficacy of Stretta procedure for gastro-esophageal reflux disease (GERD) based on changes of symptoms, medication and esophagitis grade. Methods A total of 90 patients with GERD who underwent Stretta procedure from June 2007 to March 2010 were followed up for 6 to 32 months. The health related quality of life of GERD ( GERD-HRQL), symptoms, medication and grade of esophagitis were evaluated at baseline, 6 and 12 months after the procedure, respectively. Results GERD symptoms were significantly relieved after the treatment, with 63 patients (70. 0% ) showing obvious improvement in 2 months, 15( 16. 7% ) being improved in 2 to 6 months, 8(8. 9% ) being relieved after 6 months, and 4(4. 4% ) showing no changes. The mean GERD-HRQL scores was 25.6 at baseline,and decreased to 7. 3 ( P ＜ 0. 01 ) at 6 months) and 8. 1 ( P ＜ 0. 01 ) at 12 months. The mean heartburn scores was 3.3 at baseline and decreased to 1.2 at 12 months ( P ＜ 0. 05 ). Before Stretta procedure, only 31.1% of the patients were satisfied with symptom control by medication, which was increased to 86. 7% after treatment. The score of overall satisfaction with treatment imoroved from 1.4 at baseline to 4. 0 at 12 months after the procedure (P ＜0. 01 ). All patients needed proton pump inhibitors (PPIs) to control symptoms before the treatment, including 67.8% of patients who needed PP1 combined with 2 other medicines or above, while at 6 months after the procedure, 76. 7% of patients were independent of PPI, or only accepted antacids or H2-receptor antagonists on demand. Out of 41 patients with erosive esophagitis before the procedure, 33(80. 5% ) showed normal esophagus at 6 months after the procedure, with 8 patients (19. 5% )having reflux esophagitis of Grade A. Conclusion Stretta procedure can achieve significant improvements in symptom control and degree of esophagitis, it also can decrease the use of medicine. It is well tolerated,safe, effective and endurable for GERD patients.
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