老年人食管内镜黏膜下剥离术后胃食管反流的初步评价

目的评估老年人的食管病变在进行内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）3个月后的胃食管反流情况。方法回顾性调查60岁及以上行食管ESD术后3个月及以上的患者烧心、反酸等症状的发生情况，用胃食管反流病症状量表进行评分。记录患者年龄、病变位置、大小和来源，分析软件SPSS17．0。结果共有144例患者完成了随访，其中男性86例，女性58例，中位年龄65岁（60—80岁）。食管病灶大小0．4-10cm，中位数2cm。病灶下缘距食管胃结合部0—21．5cm，25％和75％位数值分别为4．1cm和12．0cm，中位数值为8．0cm。有胃食管反流症状者40例（27．8％），诊断为胃食管反流病者11例（7．6％）。女性较男性患者容易发生胃食管反流症状（P=0．028），病灶下缘距离食管胃结合部〈2．0cm者较2．0cm以上的患者更容易发生胃食管反流病（P=0．011）。结论食管病变的ESD手术3个月后部分老年患者出现胃食管反流症状和食管炎，距离食管胃结合部2cm以内的病灶ESD术后患者可能容易发生胃食管反流病。

Assessment of gastroesophageal reflux after endoscopic submucosal dissection for esophageal lesion in the elderly patients

Objective To investigate gastroesophageal re flux symptoms after endoscopic submucosal dissection （ESD） for the patients with esophageal lesion. Methods Patients over 60 years old who underwent ESD for esophageal lesion were retrospectively included into the study. Those who had gastroesophageal surgery or ESD for gastric lesion were ex- cluded. Gastroesophageal symptom scores, age, location, size and source of esophageal lesion, follow-up of endoscopy were recorded. SPSS 17.0 software was used to analyze the data. Results In the total 144 patients completed the research. 86 were males and 58 were females. The median of age was 65 years （60-80 yrs）. The size range of esophageal lesion was 0.4-10cm with median 2cm. The lower margin of the lesions was 0-21.5cm proximal to esophagogastric junction （EGJ）. 40 patients underwent gastroesophageal reflux symptoms and 11 patients were diagnosed with gastroesophageal reflux disease （7.6%）. Female patients suffered more gastroesophageal reflux symptoms （P=0.028）. Patients with lesions involved mucosa within 2cm proximal to EGJ were prone to have gastroesophageal reflux disease after ESD for at least three months （P=0.011）. Conclusion About 1/4 elderly patients underwent gastroesophageal reflux symptoms and/or reflux esophagitis at least three months after ESD therapy for esophageal lesion. ESD for lesions distal to 38cm might cause more gastroes- ophageal reflux disease.