Stretta微量射频和腹腔镜Nissen胃底折叠术治疗胃食管反流病的疗效比较

摘要

目的 比较Stretta微量射频(SRF)和腹腔镜Nissen胃底折叠术(LNF)治疗胃食管反流病(GERD)的疗效.方法 选择90例确诊为GERD患者,所有患者行Stretta微量射频手术或腹腔镜Nissen胃底折叠手术.观察GERD术前术后症状评分、术后并发症评估、胃镜检查结果、PPI停药率.结果 90例患者均未出现严重并发症或死亡.其中51例行LNF治疗,39例行SRF治疗,随访6～12个月后,两组患者术后主要症状评分均较术前降低,LNF对GERD相关症状疗效均优于SRF组(P＜0.05).随访过程中出现并发症包括胸骨后不适或疼痛、咽痛、腹泻、腹胀、吞咽困难.大多数并发症经对症处理后4～8周后症状消失,LNF组中3例术后2周吞咽困难症状加重,2例经胃镜扩张后症状明显缓解.1例因胃镜扩张后症状仍未见好转,再次行腹腔镜手术解除梗阻,术后症状消失.两组术后并发症(胸骨后不适、咽痛、腹胀和吞咽困难)比较差异有统计学意义(P＜0.05).SRF和LNF治疗后12个月,分别66.7％和82.4％的患者不需要服用PPI,或仅仅按需服用抗酸药物.结论 SRF和LNF均能有效控制GERD相关症状,但LNF的效果更佳.%Objective To observe the curative effect of stretta microradiofrequency and laparoscopic Nissen fundoplication on gastroesophageal reflux disease (GERD).Methods A total of 90 patients with GERD were selected.All of the patients underwent stretta microradiofrequency surgery or laparoscopic nissen fundoplication surgery.The preoperative and postoperative symptom scores of GERD,postoperative complications assessment,the results of endoscopic examination,PPI discontinuation rates were observed.Results None of the 90 patients had serious complications or died.Fifty-one cases were treated with LNF and 39 cases were treated with SRF,after follow-up of 6-12 months,the main symptoms of the two groups were lower than those before surgery.The effect of LNF on GERD related symptoms was better than that of SRF group (P ＜ 0.05).During the follow-up,the complications appeared including post-sternal discomfort or pain,pharyngeal pain,diarrhea,bloating,and dysphagia.Most of the complications disappeared after 4-8 weeks of symptomatic treatment,and 3 cases in LNF group got worse in 2 weeks after surgery,and the symptoms of 2 cases were significantly alleviated after endoscopic dilation.The symptoms of one case were not improved after the gastroscope dilation surgery,but the postoperative symptoms disappeared after laparoscopic surgery.There was significant difference between the two groups in the postoperative complications of sternal discomfort,pharyngeal pain,abdominal distension and dysphagia (P ＜ 0.05).Twelve months after SRF and LNF treatment,66.7％ and 82.4％ of the patients had no requirement for PPI or simply took antacids.Conclusions SRF and LNF are effective on controlling GERD related symptoms,and LNF is more effective.