Barrett食管伴滑动性食管裂孔疝腹腔镜治疗疗效观察

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。

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

ObjectiveTo explore the improvement of quality of life and esophageal mucosal lesions after laparoscopic treatment in patients with Barrett's esophagus and hiatal hernia. MethodsA 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. ResultsPost-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). ConclusionLaparoscopic 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.