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中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 131 -137. doi: 10.3877/cma.j.issn.1674-392X.2021.02.004

所属专题： 文献；

临床论著

食管探条在腹腔镜Nissen胃底折叠术中的应用研究
吴远哲1, 胡志伟2, 吴继敏2,†(), 邓昌荣2, 战秀岚2, 王峰2, 汪忠镐3   
  1. 1. 440507　广东省，汕头大学医学院第一附属医院介入科
    2. 100035　北京，中国人民解放军火箭军特色医学中心胃食管反流外科
    3. 100035　北京，中国人民解放军火箭军特色医学中心胃食管反流外科；100053　北京，首都医科大学宣武医院血管外科
  • 收稿日期:2019-11-12 出版日期:2021-04-18
  • 通信作者: 吴继敏

Value research of intraoperative esophageal bougie applied in laparoscopic Nissen fundoplication

Yuanzhe Wu1, Zhiwei Hu2, Jimin Wu2,†(), Changrong Deng2, Xiulan Zhan2, Feng Wang2, Zhonghao Wang3   

  1. 1. Department of Invasive Technology, The First Affiliated Hospital of Shantou University Medical College, Shantou 440507, China
    2. Department of Gastroesophageal Reflux Disease, PLA Rocket Force Characteristic Medical Center, Beijing 100035, China
    3. Department of Gastroesophageal Reflux Disease, PLA Rocket Force Characteristic Medical Center, Beijing 100035, China; Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2019-11-12 Published:2021-04-18
  • Corresponding author: Jimin Wu
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引用本文：

吴远哲, 胡志伟, 吴继敏, 邓昌荣, 战秀岚, 王峰, 汪忠镐. 食管探条在腹腔镜Nissen胃底折叠术中的应用研究[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(02): 131-137.

Yuanzhe Wu, Zhiwei Hu, Jimin Wu, Changrong Deng, Xiulan Zhan, Feng Wang, Zhonghao Wang. Value research of intraoperative esophageal bougie applied in laparoscopic Nissen fundoplication[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(02): 131-137.

目的

评估术中应用食管探条对腹腔镜Nissen胃底折叠术的疗效。

方法

收集中国人民解放军火箭军特色医学中心2015年3至10月收治的120例诊断明确胃食管反流病（GERD）的患者资料。将120例GERD患者随机分为探条组和对照组，各60例。对探条组患者在胃底折叠术后立即用56F食管探条进行扩张；对照组不进行探条扩张。术后1~2周、1~3个月、6个月及1年分别对2组患者进行随访。同一患者术前术后数据采用配对t检验；组间正态数据采用独立样本t检验，非正态数据采用秩和检验进行比较。计数资料采用χ2检验进行比较。

结果

成功随访117例，3例信息获得不全。其中，探条组58例，对照组59例。2组患者手术过程顺利、无严重并发症及死亡病例。2组患者均未出现食管穿孔。2组术中出血量、手术时间及术后住院时间比较，差异均无统计学意义（P>0.05）。胃底折叠术后6个月，2组患者各症状评分均明显降低，差异均有统计学意义（P<0.05）。2组间各症状缓解率比较，差异均无统计学意义（P>0.05）。探条组吞咽困难发生率在术后1~2周、1~3个月、6个月均明显低于对照组，差异均有统计学意义（P<0.05）。术后1年，2组间吞咽困难发生率比较，差异无统计学意义（P>0.05）。探条组吞咽困难评分中位数在术后1~2周、1~3个月、6个月、1年均明显低于对照组，差异均有统计学意义（P<0.05）。2组间其他并发症发生率差异无统计学意义（P>0.05）。

结论

腹腔镜Nissen胃底折叠术中应用食管探条可降低术后吞咽困难发生率，且术后时间越长，差异越小；还可降低术后吞咽困难程度，提高患者的舒适度。术中应用食管探条对其他并发症发生率及临床疗效无明显差异，无食管穿孔及相关并发症，值得在临床上推广及应用。

关键词: 胃食管反流病, 腹腔镜胃底折叠术, 食管探条, 吞咽困难
Objective

To investigate the effect of intraoperative esophageal bougie applied in laparoscopic Nissen fundoplication.

Methods

We collected 120 cases ofgastroesophageal reflux disease (GERD) in PLA Rocket Force Characteristic Medical Centerfrom March 2015 to October 2015 and divided them into two groups randomly, with 60 cases in bougie group and 60 cases in control group. The bougie group was dilated with a 56F esophageal bougie after the completion of the fundoplication, while the control group did not perform the dilatation. We conducted the follow-up of both groups at 1 week, 2 weeks, 1 months, 2 months, 3 months, 6 months and 1 year. The same patient's postoperative data adopted a pair T test; the inter-component normal data employed the independent sample T test, and the non-normal data was compared by rank sum inspection. The count data was compared using χ2 inspection.

Results

117 cases were successfully followed up, with three missing cases. There were 58 case in bougie group and 59 in control group. The surgical procedure was successful for each patient, without serious complications and deaths during the procedure. There were no esophageal perforations in both groups. The amount of bleeding, operative time and postoperative hospital stay had nosignificant differences between two groups (P>0.05). At six months after fundoplication, the symptom score of the two groupswere significantly reduced (P<0.05). Thecorresponding symptomatic relief rateshad nosignificant difference between two groups (P>0.05). Postoperative dysphagia rates were lower in bougie group than those in the control groupat1week, 2weeks, 1 months, 2 months, 3 months, and 6 months (P<0.05); but postoperative dysphagia rate at 1year had no significant difference between twogroups. The median dysphagia scores were lower in bougie group than those of in the control group at 1 week, 2 weeks, 1 months, 2 months, 3 months, 6 months and 1 year (P<0.05). There was no significant difference in the incidence of other complications between 2 groups (P>0.05).

Conclusion

The application of intraoperativeesophageal bougie during laparoscopic Nissen fundoplication significantly reduces the rates of postoperative dysphagia, and the differences of postoperative dysphagia rates between two groups diminish with time. The application of intraoperativeesophageal bougie during laparoscopic Nissen fundoplication can significantly reduce thedegree of postoperative dysphagia, and improve the comfort of patients. The application of intraoperativeesophageal bougie during laparoscopic Nissen fundoplicationhas no significant difference on the rates of other complications andclinical outcome, and has no esophagus perforation orrelated complications, and it is deserved promotion and application in clinic.

Key words: Gastroesophageal reflux disease, Laparoscopic fundoplication, Esophageal bougie, Dysphagia
表1 2组患者的一般资料
组别 例数 男性/女性(例) 平均年龄(岁,±s) 病程(年,±s) 体质量指数(kg/cm2,±s)
探条组 60 56.29/31 57.4±11.0 10.6±10.8 24.3±2.7
对照组 60 32/28 53.2±13.1 9.0±9.0 23.9±2.7
P值   >0.05 >0.05 >0.05 >0.05
表2 2组患者术前检查比较
组别 例数 DeMeester评分(分,±s) pH≤4所占百分比(%) 反流性食管炎(%) LES长度(cm,±s) LESP(mmHg,±s) UESP(mmHg,±s) LES残余压(mmHg,±s) DCI(mmHg·cm·s,±s) DL 食管动力异常(%)
探条组 60 15.2±17.8 4.2±5.4 45 2.9±0.7 8.5±6.3 66.7±32.8 5.4±4.0 561.6±396.2 5.3±2.5 28.3
对照组 60 20.7±25.6 5.2±7.1 43.3 2.8±0.7 10.0±7.5 56.4±28.5 5.0±3.3 519.9±384.2 6.0±2.0 35
P值   >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
图1 腹腔镜Nissen胃底折叠术中放置食管探条膈裂孔前后变化
表3 2组患者手术状况比较（±s）
组别 例数 手术时间(min) 术中出血量(ml) 术后住院天数(d)
探条组 58 100.8±20.7 27.1±13.2 5.4±1.3
对照组 59 94.2±21.7 24.5±12.3 5.5±1.2
t值   -1.838 -1.158 0.704
P值   >0.05 >0.05 >0.05
表4 2组患者手术疗效比较（±s）
组别 例数 治疗前症状评分(分) 治疗后症状评分(分) 症状缓解率(%)
探条组 58      
  反酸 57 8.0±0.5a 1.1±0.6b 86.0±8.0c
  烧心 58 8.0±0.3a 1.1±0.6b 86.0±8.0c
  胸痛 21 6.9±0.6a 0.9±0.3b 86.8±4.6c
  反食 20 7.4±1.1a 1.7±0.8b 77.7±9.6c
对照组 59      
  反酸 59 8.1±0.7a 1.3±0.8b 84.5±10.3c
  烧心 59 8.1±0.7a 1.3±0.8b 84.6±10.3c
  胸痛 19 7.1±0.7a 1.1±0.7b 84.3±8.5c
  反食 20 7.4±1.1a 1.4±0.8b 80.1±10.1c
表5 2组患者术后不同时间段吞咽困难发生率比较[例（%）]
时间 探条组(58例) 对照组(59例) χ2值 P值
1周 39(67.2) 56(94.9) 14.671 <0.05
2周 28(48.3) 52(88.1) 21.490 <0.05
1个月 22(37.9) 44(74.6) 15.973 <0.05
2个月 10(17.2) 24(40.7) 7.793 <0.05
3个月 6(10.3) 17(28.8) 6.317 <0.05
6个月 2(3.4) 9(15.3) 4.786 <0.05
1年 1(1.7) 4(6.8) 0.800 >0.05
表6 2组患者术后不同时间段吞咽困难评分中位数比较[M（Min～Max）]
时间 探条组(58例) 对照组(59例) Z值 P值
1周 2.0 (0~4 ) 3.5 (0~7 ) -5.048 <0.05
2周 0(0~4) 3.0 (0~6 ) -6.649 <0.05
1个月 0(0~3) 2.0(0~6) -4.426 <0.05
2个月 0(0~3) 0(0~6) -2.962 <0.05
3个月 0(0~2) 0(0~5) -2.582 <0.05
6个月 0(0~2) 0(0~5) -2.215 <0.05
1年 0(0) 0(0~2) -2.503 <0.05
图2 2组患者术后不同时间段吞咽困难发生率比较
表7 2组患者术后其他并发症发生率的比较[例（%）]
并发症 探条组(58例) 对照组(59例) χ2值 P值
腹胀 14(24.1) 15(25.4) 0.026 >0.05
嗳气不畅 4(6.9) 6(10.2) 0.091 >0.05
肠胀气 2(3.4) 3(5.1) 0.000 >0.05
排气过多 4(6.9) 6(10.2) 0.091 >0.05
胸骨不适 0(0) 1(1.7) - >0.05
腹泻 1(1.7) 4(6.8) 0.800 >0.05
便秘 2(3.4) 2(3.4) 0.000 >0.05
体重减轻 0(0) 2(3.4) - >0.05
胸背痛 0(0) 1(1.7) - >0.05
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