Stretta射频治疗和腹腔镜Nissen胃底折叠术治疗胃食管反流相关性严重哮喘的比较研究

摘要

目的 观察比较Stretta射频治疗(SRF)和腹腔镜Nissen胃底折叠术(LNF)对合并严重哮喘症状的胃食管反流病(gastroesophageal reflux disease,GERD)的疗效.方法 收集2008年1月-2009年9月第二炮兵总医院胃食管反流中心收治有GERD相关严重哮喘症状并行抗反流术治疗的137例,其中82例行SRF治疗,55例行LNF治疗.SRF的治疗部位覆盖胃食管结合部上2.0 cm和下0.5 cm,共6个平面.LNF将胃底以360度包绕食管下端,以不可吸收丝线固定2或3针,合并食管裂孔疝者同时行食管裂孔疝修补术.结果 抗反流术后12个月,LNF组的食管症状、哮喘症状和耳鼻喉症状分别从17.2±10.1、31.9±6.6和21.1±11.8下降到5.0±6.2、11.5±10.2和6.3±6.8；SRF组的食管症状、哮喘症状和耳鼻喉症状分别从17.2±10.1、31.9±6.6和21.1±11.8下降到5.0±6.2、11.5±10.2和6.3±6.8.组间比较症状缓解率,LNF对三类症状的疗效均优于SRF,差异有统计学意义(P ＜0.001).LNF组术后吞咽困难、嗳气困难或腹胀并发症共计13例,1月至数月缓解.SRF组仅2例术后吞咽困难,5d内缓解.结论 SRF和LNF均能有效控制GERD的食管症状、哮喘症状和耳鼻喉症状,以LNF的效果更佳.而SRF术后并发症更少并且轻微.%Objective To investigate and compare the curative effect of Stretta radiofrequency (SRF) and laparoscopic Nissen fundoplication (LNF) in treatment of gastroesophageal reflux disease (GERD) related severe asthma.Methods A total of 137 patients with GERD related severe asthmatic symptoms were treated with antirefiux therapy in GER Center of General Hospital of Second Artillery Command during January 2008 and September 2009.Among the 137 patients,82 patients underwent SRF,and 55 patients underwent LNF.The SRF was applied at 6 levels in a space of 2.0 cm above and 0.5 cm below gastroesophageal junction of esophagus.The LNF had a 360 degree fundoplication fixed by 2 to 3 nonabsorbable sutures,and patients combined with hiatus hernia underwent hiatus hernia repair at the same time.Results Twelve months after antireflux surgery,the oesophageal,asthma and ENT symptom scores were reduced from 17.2 ± 10.1,31.9 ±6.6 and 21.1 ± 11.8 to 5.0 ±6.2,11.5 ± 10.2 and 6.3 ±6.8 in LNF group,and from 17.2 ± 10.1,31.9 ± 6.6 and 21.1 ± 11.8 to 5.0 ± 6.2,11.5 ± 10.2 and 6.3 ± 6.8 in SRF group.Symptomatic relief rates in LNF group were significantly higher in all the three symptoms than those in SRF group (P ＜ 0.001).Complications such as dysphagia,hard belching or abdominal distension were found in 13 patients in LNF group,which were relieved within 1 month or later.Only 2 patients had postoperative dysphagia,which was relieved within 5 d in SRF group.Conclusion Both SRF and LNF may be effective in controlling oesophageal,asthma and ENT symptoms of GERD,and LNT has better effect with less and milder complication of SRF.