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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (06) : 663 -667. doi: 10.3877/cma.j.issn.1674-392X.2022.06.012

临床论著

Barrett食管伴滑动性食管裂孔疝腹腔镜治疗疗效观察
李颖1, 张若蹊2, 刘婷1, 刘殿刚2,†()   
  1. 1. 100053　北京，首都医科大学宣武医院麻醉手术科
    2. 100053　北京，首都医科大学宣武医院普外科胃食管反流病诊疗中心
  • 收稿日期:2022-02-28 出版日期:2022-12-18
  • 通信作者: 刘殿刚
  • 基金资助:
    北京市自然科学基金-海淀原始创新联合基金(303-01-003-0078)

Improvement in mucosa and quality of life in patients with Barrett's esophagus complicated with sliding hiatal hernia after laparoscopic treatment

Ying Li1, Ruoxi Zhang2, Ting Liu1, Diangang Liu2,†()   

  1. 1. Department of Anesthesiology, Xuanwu Hospital Capital Medical University, Beijing 100053, China
    2. Department of General Surgery, Gastroesophageal Reflux Disease Center, Xuanwu Hospital Capital Medical University, Beijing 100053, China
  • Received:2022-02-28 Published:2022-12-18
  • Corresponding author: Diangang Liu
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引用本文：

李颖, 张若蹊, 刘婷, 刘殿刚. Barrett食管伴滑动性食管裂孔疝腹腔镜治疗疗效观察[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(06): 663-667.

Ying Li, Ruoxi Zhang, Ting Liu, Diangang Liu. Improvement in mucosa and quality of life in patients with Barrett's esophagus complicated with sliding hiatal hernia after laparoscopic treatment[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(06): 663-667.

目的

探究合并滑动性食管裂孔疝的Barrett食管患者经腹腔镜下治疗后生活质量和食管黏膜病变的改善情况。

方法

回顾性收集首都医科大学宣武医院胃食管反流中心2016年1月至2020年12月诊断为Barrett食管伴滑动性食管裂孔疝患者23例，接受腹腔镜食管裂孔疝修补+胃底折叠术，于术前和术后12周时行胃镜、胃食管反流病自测量表（Gerd Q）评分、反流症状指数（RSI）评分、健康调查量表36（SF-36）调查问卷，评估患者术后生活质量和食管黏膜改善情况。

结果

23例伴滑动性食管裂孔疝的Barrett患者术后12周随访显示3例患者黏膜病变部分消退。患者术后GerdQ、RSI相较术前均有明显改善（GerdQ：5.78±1.54 vs 11.65±1.50，P=0.00；RSI：9.70±1.92 vs 18.57±3.01，P=0.00），SF-36量表仅在生理功能方面改善不明显（85.87±4.16 vs 86.43±3.12，P=0.31），生理职能、情感职能、活力、精神健康、社会功能、躯体疼痛和总体健康方面均明显改善（生理职能：66.43±6.13 vs 35.48±2.86，P=0.00；情感职能：73.74±4.91 vs 65.22±2.58，P=0.00；活力：56.96±3.80 vs 50.30±4.56，P=0.00；精神健康：62.09±4.89 vs 53.26±2.07，P=0.00；社会功能：81.39±4.42 vs 74.00±3.59，P=0.00；躯体疼痛：80.00±6.84 vs 75.30±10.27，P=0.00；总体健康：69.17±5.68 vs 60.17±4.61，P=0.00）。

结论

腹腔镜食管裂孔疝修补+胃底折叠术对伴滑动性食管裂孔疝的Barrett食管患者生活质量和黏膜病变均有一定改善。

关键词: Barrett食管, 滑动性食管裂孔疝, 腹腔镜, 疝修补术, 胃底折叠术, 生活质量
Objective

To explore the improvement of quality of life and esophageal mucosal lesions after laparoscopic treatment in patients with Barrett's esophagus and hiatal hernia.

Methods

A retrospective collection of 23 patients diagnosed with Barrett esophagus complicated by hiatal hernia and undergoing laparoscopic treatment at the Xuanwu Hospital Gastroesophageal Reflux Center of Capital Medical University from January 2016 to December 2020, included gastroscopy, GerdQ, RSI, and SF-36 questionnaires before and at 12 weeks postoperatively to assess patients' postoperative quality of life and esophageal mucosal improvement.

Results

Post-operative 12-week visits of 23 Barrett patients with sliding hiatal hernia showed partial regression of mucosal lesions in three patients. Patients showed significant improvement in postoperative GerdQ and RSI compared with preoperative surgery (GerdQ: 5.78±1.54 vs 11.65±1.50, P=0.00; RSI: 9.70±1.92 vs 18.57±3.01, P=0.00), The SF-36 scale showed little improvement only in its physiology (85.87±4.16 vs 86.43±3.12, P=0.31), Physical function, emotional function, vitality, mental health, social function, physical pain, and general health were all significantly improved (physiological function: 66.43±6.13 vs 35.48±2.86, P=0.00; Emotional function: 73.74±4.91 vs 65.22±2.58, P=0.00; Vitality: 56.96±3.80 vs 50.30±4.56, P=0.00; Mental health: 62.09±4.89 vs 53.26±2.07, P=0.00; Social function: 81.39±4.42 vs 74.00±3.59, P=0.00; Physical pain: 80.00±6.84 vs 75.30±10.27, P=0.00; Overall health: 69.17±5.68 vs 60.17±4.61, P=0.00).

Conclusion

Laparoscopic repair of esophageal hiatal hernia with fundoplication could improve quality of life and mucosal lesions in Barrett's esophagus patients complicated by sliding hiatal hernia.

Key words: Barrett esophagus, Laparoscopic, Sliding esophageal hiatus hernia, Hiatal hernia repair, Fundoplication, Quality of life
表1 伴滑动性食管裂孔疝的Barrett食管患者一般临床特点[例（%）]
性别 体质量指数 居住地 文化程度
男性 女性 <18.5 kg/m2 18.5~22.9 kg/m2 23~29.9 kg/m2 ≥30 kg/m2 农村 城市 大学及以上 高中 初中及小学
12(52.17) 11(47.83) 0 1(4.35) 18(78.26) 4(17.39) 7(30.43) 16(69.57) 3(13.04) 6(26.09) 14(60.87)
吸烟史 饮酒史 典型症状 不典型症状
反流 胃灼热 胸痛 上腹痛 上腹烧灼感 嗳气 伴食管外症状
11(47.83) 10(43.48) 21(91.30) 19(82.61) 10(43.48) 4(17.39) 5(21.74) 18(78.26) 6(26.09)
表2 伴滑动性食管裂孔疝的Barrett食管患者高分辨率食管测压数据（±s）
组别 例数 LESL(cm) LESP(mmHg) d(cm)
长BE 4 2.28±0.17 7.43±0.17 3.63±0.46
短BE 19 3.01±0.42 8.66±0.37 2.47±0.25
t   -3.39 -6.42 7.30
P   0.003 0.000 0.000
表3 23例伴滑动性食管裂孔疝的Barrett食管患者术前、术后的Gerd Q、RSI、SF-36评分比较（±s）
时间 Gerd Q RSI SF-36
生理功能 生理职能 情感职能 活力 精神健康 社会功能 躯体疼痛 总体健康
术前 11.65±1.50 18.57±3.01 86.43±3.12 35.48±2.86 65.22±2.58 50.30±4.56 53.26±2.07 74.00±3.59 75.30±10.27 60.17±4.61
术后 5.78±1.54 9.70±1.92 85.87±4.16 66.43±6.13 73.74±4.91 56.96±3.80 62.09±4.89 81.39±4.42 80.00±6.84 69.17±5.68
t 14.19 12.71 1.03 -27.30 -7.39 -9.88 -9.33 -7.79 -4.10 -8.25
P 0.00 0.00 0.31 0.00 0.00 0.00 0.00 0.00 0.00 0.00
[1]
中华医学会消化病学分会. Barrett食管诊治共识(修订版, 2011年6月,重庆)[J]. 中华消化杂志, 2011, 31(8): 555-556.
[2]
中华医学会消化病学分会. 2020中国胃食管反流病专家共识[J]. 中华消化杂志, 2020, 40(10): 649-663.
[3]
杜亚君, 尚占民, 秦昌富. 高分辨率食管测压技术在腹腔镜治疗食管裂孔疝中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(6): 522-524.
[4]
Steven RD. Laparoscopic hernia repair and fundoplication for gastroesophageal reflux disease[J]. Gastrointest Endosc Clin N Am, 2020, 30(2): 309-324.
[5]
Alice S, Dan LD. The management of hiatal hernia: an update on diagnosis and treatment[J]. Med Pharm Rep, 2019, 92(4): 321-325.
[6]
Wani S. Advances and opportunities in Barrett’s esophagus[J]. Gastrointest Endosc Clin N Am, 2021, 31(1): xv-xvi.
[7]
Peter JK, Ravinder KM, Serhat B, et al. Chicago classification update(v4. 0): technical review of high-resolution manometry metrics for ECJ barrier function[J]. Neurogastroenterol Motil, 2021, 33(10): e14113.
[8]
Zaydfudim VM. Long-term outcomes in mesh versus no mesh laparoscopic repair of hiatal hernia[J]. Surgery, 2021, 169(4): 987.
[9]
王少鑫, 浦江, 崔立红. 胃食管反流病量表(GerdQ)在临床诊治中的应用[J]. 中华保健医学杂志, 2014, 16(4): 299-300.
[10]
李进让, 肖水芳, 李湘平, 等. 咽喉反流性疾病诊断与治疗专家共识(2015年)解读[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(5): 327-332.
[11]
Belvederi MM, Cecere AC, Masotti M, et al. Biopsychosocial predictors of interferon-related depression in patients with Hepatitis C[J]. Asian J Psychiatr, 2017, 26: 24-28.
[12]
李春波, 何燕玲. 健康状况调查问卷SF-36的介绍[J]. 国外医学(精神病学分册), 2002, 29(2): 116-119.
[13]
Mittal RK, Kumar D, Jiang Y. Sliding hiatus hernia: a two-step pressure pump of gastroesophageal reflux[J]. Gastroenterology, 2021, 161(1): 339-341.e1.
[14]
Cook MB, Thrift AP. Epidemiology of Barrett's Esophagus and Esophageal Adenocarcinoma: implications for screening and surveillance[J]. Gastrointest Endosc Clin N Am, 2021, 31(1): 1-26.
[15]
Taraszewska A. Risk factors for gastroesophageal reflux disease symptoms related to lifestyle and diet[J]. Rocz Panstw Zakl Hig, 2021, 72(1): 21-28.
[16]
Talley NJ, Zand Irani M. Optimal management of severe symptomatic gastroesophageal reflux disease[J]. J Intern Med, 2021, 289(2): 162-178.
[17]
Wang AM, Wang G, Huang N, et al. Association between laryngopharyngeal reflux disease and autonomic nerve dysfunction [J]. Eur Arch Otorhinolaryngol, 2019, 276(8): 2283-2287.
[18]
Choi JM, Yang JI, Kang SJ, et al. Association Between Anxiety and Depression and Gastro-esophageal Reflux Disease: Results From a Large Cross-sectional Study[J]. J Neurogastroenterol Motil, 2018, 24(4): 593-602.
[19]
Tack J, Pandolfino JE. Pathophysiology of Gastroesophageal Reflux Disease[J]. Gastro-enterology, 2018, 154(2): 277-288.
[20]
Parsel SM, Wu EL, Riley CA, et al. Gastroesophageal and Laryngopharyngeal Reflux Associated With Laryngeal Malignancy: A Systematic Review and Meta-analysis[J]. Clin Gastroenterol Hepatol, 2019, 17(7): 1253-1264.
[21]
克力木·阿不都热依木, 麦麦提艾力·麦麦提明. 我国胃食管反流病抗反流外科的回顾与展望[J]. 中华消化外科杂志, 2021, 20(6): 639-642.
[22]
杨慧琪, 刘亦婷, 陈杰, 等. 腹腔镜胃底折叠术治疗胃食管反流病合并巴雷特食管的临床疗效[J]. 中华消化外科杂志, 2018, 17(12): 1215-1219.
[23]
Kayaoglu HA. Correlation of the gastroesophageal flap valve grade with the surgery rate in patients with gastroesophageal reflux disease[J]. Surg Endosc, 2013, 27(3): 801-807.
[24]
王建, 史以超, 赵会君, 等. 胃食管反流病患者伴有或不伴有食管黏膜损伤与食管上、下括约肌压力相关性研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2019, 13(1): 32-35.
[25]
Zehetner J, DeMeester SR, Ayazi S, et al. Long-term follow-up after antireflux surgery in patients with Barrett's esophagus[J]. J Gastrointest Surg, 2010, 14(10): 1483-1491.
[26]
Trudie AG, Pedro L, Maria AC, et al. Concomitant endoscopic radiofrequency ablation and laparoscopic reflux operative results in more effective and efficient treatment of Barrett esophagus[J]. J Am Coll Surg, 2011, 213(4): 486-492.
[27]
Fabian T, Leung A. Epidemiology of Barrett's esophagus and esophageal carcinoma[J]. Surg Clin North Am, 2021, 101(3): 381-389.
[28]
Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: an updated ACG guideline[J]. Am J Gastroenterol, 2022, 117(4): 559-587.
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