腹腔镜下贲门肌层切开术及Dor胃底折叠术治疗贲门失弛缓症临床分析

目的探讨腹腔镜下食管下括约肌切开及Dor胃底折叠术治疗贲门失弛缓症的可行性和临床疗效。 方法回顾性分析2010年1月至2015年7月,新疆维吾尔自治区人民医院收治的14例贲门失弛缓症患者的临床资料。 结果14例患者均顺利在胃镜定位下行腹腔镜下食管下括约肌切开及胃底折叠术,无中转开腹,手术时间65～125 min,术中出血量5～25 ml,未发生消化道漏,术后平均住院5～7 d。 结论腹腔镜下食管下括约肌切开及胃底折叠术治疗贲门失弛缓症创伤小,术后恢复快,疗效客观,是安全可行的手术方式。     

胃食管反流病内镜下治疗的方法与评价

胃食管反流病是一种临床上常见的消化系统疾病。在胃食管反流病的治疗方面，长时间内集中于药物治疗和腹腔镜胃底折叠术两种方式。随着近年来内镜技术的发展，出现了诸多创伤小、不良反应少的内镜新技术，例如：内镜下射频消融治疗、内镜下贲门黏膜缩窄术、内镜下胃底折叠术等。内镜治疗技术的兴起，对胃食管反流病的治疗方式进行了补充并提供了新的治疗选择。本文就内镜下胃食管反流病的治疗方法及其评价作一综述。     

双镜联合在贲门、胃底＞2cm肿瘤术中的应用

[目的]探讨胃镜腹腔镜双镜联合在贲门、胃底2 cm黏膜下肿瘤(submucosal tumor,SMT)术中的应用价值。[方法]对58例贲门、胃底2 cm SMT手术患者进行回顾性分析。双镜联合组:19例,采用双镜联合下贲门、胃底2 cm SMT切除术;胃镜组:18例,采用胃镜下贲门、胃底2 cm SMT切除术;腹腔镜组:21例,采用腹腔镜下贲门、胃底2 cm SMT切除术。根据手术时间,术中出血量,住院费用,住院时间,术后胃潴留、反流等情况比较3组治疗效果。[结果]双镜联合组、胃镜组、腹腔镜组的住院费用、住院时间比较均差异无统计学意义(P0.05)。双镜联合组在手术时间、术中出血量明显少于胃镜组(P0.05),但与腹腔镜组比较差异无统计学意义(P0.05)。双镜联合组在术后胃潴留、反流症状优于腹腔镜组(P0.05),但与胃镜组比较差异无统计学意义(P0.05)。[结论]双镜联合对贲门、胃底2 cm SMT手术是安全、有效的。     

胃食管反流病的最新治疗进展

胃食管反流病是常见的消化道疾病之一,以质子泵抑制剂为基础的药物治疗联合生活方式调整是其主要治疗方法,然而药物只能控制症状,患者需要长期服用。 腹腔镜下胃底折叠术是可供选择的治疗方案,但创伤相对较大,住院时间长,术后吞咽困难、腹胀的发生率较高,远期随访显示多数患者再次服用药物治疗。近十年来,随着质子泵抑制剂长期使用后药物相关副作用的报道,外科胃底折叠术开展量的下降以及内镜下治疗技术的出现,GERD的治疗格局逐渐发现改变。本文就GERD目前的治疗方法（生活方式调整、药物、内镜、手术）及未来的发展方向做一综述。     

腹腔镜下食管裂孔疝修补胃底折叠术巡回护士的配合体会

目的总结腹腔镜食管裂孔疝修补胃底折叠术中巡回护士的护理配合体会,便于指导临床手术配合工作。 方法回顾性分析2013年4月至2015年9月,新疆维吾尔自治区人民医院280例腹腔镜下食管裂孔疝修补胃底折叠术巡回护士的手术配合及护理措施。 结果280例患者手术顺利,无中转开腹或开胸。 结论巡回护士充分的术前准备、准确的体位摆放、密切的术中巡回配合是保证腹腔镜下食管裂孔疝修补胃底折叠术顺利完成的关键之一。     

双镜治疗对食管-胃底静脉曲张患者血液指标的影响

回顾性分析2012年2月至2019年10月就诊于嘉兴市第一医院的135例肝硬化伴食管-胃底静脉曲张破裂出血患者的病历资料,并根据手术方式分为腹腔镜组(行腹腔镜脾切除+贲门周围血管离断术,12例)、胃镜组(行单纯胃镜下治疗,77例)和双镜联合组(行腹腔镜下脾切除+贲门周围血管离断术联合胃镜下治疗,46例)。通过比较3组患...     

双镜治疗对食管-胃底静脉曲张患者血液指标的影响

回顾性分析2012年2月至2019年10月就诊于嘉兴市第一医院的135例肝硬化伴食管-胃底静脉曲张破裂出血患者的病历资料,并根据手术方式分为腹腔镜组(行腹腔镜脾切除+贲门周围血管离断术,12例)、胃镜组(行单纯胃镜下治疗,77例)和双镜联合组(行腹腔镜下脾切除+贲门周围血管离断术联合胃镜下治疗,46例)。通过比较3组患者治疗前与治疗后3个月内肝功能﹑肾功能﹑凝血功能指标发现,双镜联合组患者治疗后总胆红素、直接胆红素、球蛋白、凝血酶原时间、国际标准化比值、纤维蛋白原和D-二聚体均较治疗前改善,而腹腔镜组和胃镜组治疗后获得改善的指标较少。这一结果表明双镜联合治疗后肝硬化伴食管-胃底静脉曲张破裂出血患者的肝、肾与凝血功能的恢复优于单纯腹腔镜和胃镜下治疗。     

腹腔镜抗反流手术术后并发症的处理

目的探讨腹腔镜抗反流手术术后并发症的评估及处理方法。 方法回顾性分析2005年9月至2014年4月,新疆维吾尔自治区人民医院施行腹腔镜抗反流手术725例患者的临床资料,并对并发症患者进行治疗分析。 结果725例患者均成功完成食管裂孔疝修补＋胃底折叠术。术后并发症患者45例,其中吞咽困难21例,食管裂孔疝复发(折叠的胃底疝入胸腔)4例,症状复发14例,胃肠胀气综合征6例。随访6个月至9年,平均36.6个月。 结论腹腔镜抗反流手术并发症的发生率及其后果主要与术前评估、术者经验、围手术期饮食指导和患者的依从性相关。     

术中保温对腹腔镜下食管裂孔疝修补术联合胃底折叠术患者的护理效果观察

目的探讨术中保温护理在腹腔镜下食管裂孔疝修补术联合胃底折叠术中的应用效果。 方法前瞻性研究2016年2月至2016年11月,新疆维吾尔自治区人民医院92例行腹腔镜下食管裂孔疝修补术联合胃底折叠术患者临床资料,将92例患者根据数字表法随机分为观察组（46例）和对照组（46例）,对照组手术中采用常规护理,观察组在对照组的常规护理基础上施以保温护理措施,比较2组患者的术中体温、术中出血量、术后体温、术后苏醒时间、拔除气管插管时间等情况。 结果与对照组相比,观察组术中体温、胃底折叠术时体温、术毕体温、术后15 min体温均高,术中出血量减少、术后拔管短,差异均有统计学意义（P <0.05 ）。 结论腹腔镜下食管裂孔疝修补术联合胃底折叠术中常规护理的基础上加以保温护理能够保持术中患者体温稳定,减少手术患者术中低体温情况的发生及术中出血量,提高手术效率。     

食管裂孔疝围手术期加速康复护理体会

目的食管裂孔疝的加速康复护理围手术期的护理措施的优化。 方法回顾分析在接受腹腔镜下食管裂孔疝修补+胃底折叠术治疗的食管裂孔疝的32例患者围手术期的系统性护理措施,总结食管裂孔疝围手术期的快速康复护理要点。 结果32例患者均顺利完成手术,术后胃管留置（22.4±3.5）h、腹腔引流管（30.2±4.6）h、1例出现气胸的胸腔闭式引流69 h;恢复排气时间（21.3±2.4）h、排便时间（37.6±3.2）h、进食时间为（23.5±2.6）h;并发症发生率方面出现吞咽困难2例、气胸1例。 结论围手术期的优化护理措施,一定程度上加快了食管裂孔疝患者术后康复。     

Endoscopic measurement of cardia circumference as an indicator of GERD

BACKGROUND: It is theorized that repeated gastric distention leads to dilatation of the cardia and the development of GERD. We hypothesize that cardia circumference correlates with the presence and the severity of GERD, and we developed software to measure cardia circumference from static endoscopic images. Our aims were to validate the software and to quantify cardia circumference along the spectrum of GERD. METHODS: Software-based measurements were compared with actual measurements in animal and mechanical models. A retrospective review of an endoscopic database and patient charts produced 273 subjects, grouped as follows: controls, GERD, < or = 3-cm Barrett's esophagus, or > 3-cm Barrett's esophagus. A blinded abstractor measured cardia circumference by using images from the database. RESULTS: Software and actual measurements correlated closely and were reproducible among observers. Median cardia circumference for each group was the following: control, 31.8 mm; GERD, 37.8 mm; < or = 3-cm Barrett's esophagus, 38.4 mm; and > 3-cm Barrett's esophagus, 45.0 mm (p < 0.001). By using 34.3 mm as a cutoff, cardia circumference was 85.3% sensitive and 89.6% specific for the diagnosis of GERD. CONCLUSIONS: There was a direct relationship between cardia circumference and the presence of GERD. This finding augments our understanding of the anatomic contributions of the esophagogastric junction in the pathogenesis of GERD. Cardia measurement may prove to be a useful diagnostic tool.     

Endoscopic therapy for gastroesophageal reflux disease

Many new and developing endoscopic techniques for treatment of gastroesophageal reflux disease (GERD) are now or will soon be available for clinical use. These new therapies are directed to the gastroesophageal junction and include three basic techniques, which are outlined in this review: thermal remodeling and neurolysis of the lower esophageal sphincter (LES) zone; bulking or reinforcing of the LES; and plicating gastric folds at the gastric cardia. Only two of these treatments, radiofrequency ablation and fundic fold plication, have been approved by the US Food and Drug Administration (FDA). Published clinical research on endoscopic treatment is reviewed, although it is mostly comprised of open-label trials and anecdotal clinical reports. Complications of endoscopic GERD treatments are described as well as real and potential pitfalls of these techniques. Problems caused by premature introduction of endoscopic GERD treatments into the marketplace are also discussed, along with the rationale for FDA approval of similar devices.     

Endoscopic therapies for the management of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common disorder with rising incidence worldwide and very high medical costs to society. The medical management of the disease i.e. lifestyle modifications and proton pump inhibitors reaches excellent results in most cases, but it needs to be continued, lifelong; the real cure of the disease is nowadays laparoscopic fundoplication, which is effective and safe in over 95% of well selected patients to provide a durable high quality of life. A very attractive alternative to these well established therapies is the endoscopic treatment of GERD, that employs different endoluminal technologic skills: plication of gastric cardia folds by suturing devices, radiofrequencies thermal-induced cardial fibrosis and bulking or sclerosing agents local injections have been recently tried and validated by different very experienced endoscopic groups. Although endoscopic therapy of GERD seems to be safe and feasible, a definite judgement awaits the results of multicentric controlled studies and longer periods of follow-up; for the present they must be restricted to well experienced endoscopists working to these controlled trials.     

Feasibility, safety, and efficacy of the Stretta procedure in Japanese patients with gastroesophageal reflux disease: first report from Asia

Background In recent years, various endoscopic treatments have become available to treat gastroesophageal reflux disease (GERD) in Western countries. The Stretta procedure, which uses radiofrequency energy, is one type of safe and effective endoluminal treatment for GERD. However, the feasibility, safety, and efficacy of the Stretta procedure in Japanese patients with GERD, who differ from Western peoples in their physiological characteristics, are not known. In 2006, we imported a Stretta system from the United States and investigated important clinical aspects of the system in Japanese patients with GERD. Methods This study was an open-label trial that enrolled patients with GERD who desired to undergo the Stretta procedure. Heartburn scores, medication use, overall satisfaction with the procedure, and adverse events were evaluated. Results Nine patients received the Stretta treatment between February and September 2006. Esophagogastroduodenoscopy just after treatment revealed a remarkable reduction in the expansion of the gastric cardia and small erosions in all patients. At 3 or 6 months after treatment, heartburn scores were significantly improved compared with pretreatment scores (5.0 ± 1.7 pretreatment vs. 0.7 ± 1.4 posttreatment, P = 0.007). In six of nine patients (66.7%), treatment significantly (P = 0.009) decreased medication use. There were no major adverse events. All patients were satisfied with this treatment. Conclusions The Stretta procedure safely reduced GERD symptoms and decreased medication use in Japanese patients with GERD. This treatment may thus be very useful for such patients, and it is hoped that a nationwide trial will be undertaken in Japan to obtain more extensive data.     

Short-segment Barrett��s esophagus and cardia intestinal metaplasia: A comparative analysis

AIM:To investigate the endoscopy and histology of short-segment Barrett’s esophagus (SSBE) and cardia intestinal metaplasia (CIM),and their correlation with Helicobacter pylori (H. pylori) gastritis and gastroesophageal reflux disease (GERD). METHODS:Biopsy specimens were taken from 32 SSBE patients and 41 CIM patients with normal appearance of the esophagogastric junction. Eight biopsy specimens from the lower esophagus,cardia,and gastric antrum were stained with hematoxylin/eosin,Alcian blue/periodic acid-Schiff,Alcian blue/high iron diamine and Gimenez dye. Results were graded independently by one pathologist. RESULTS:The SSBE patients were younger than the CIM patients (P < 0.01). The incidence of dysplasia and incomplete intestinal metaplasia subtype was higher in SSBE patients than in CIM patients (P < 0.01). H. pylori infection was correlated with antral intestinal metaplasia (P < 0.05),but not with reflux symptomatic,endoscopic,or histological markers of GERD in CIM patients. SSBE was correlated with reflux symptomatic and endoscopic esophagitis (P < 0.01),but not with H. pylori infection and antral intestinal metaplasia. CONCLUSION:Dysplasia risk is significantly greater in SSBE patients than in CIM patients. CIM is a manifestation of H. pylori-associated and multifocal atrophic gastritis,whereas SSBE may result from GERD.     

Prevalence and distribution of Helicobacter pylori in gastroesophageal reflux disease: a study from the East

OBJECTIVES: The relationship between Helicobacter pylori infection and gastroesophageal reflux (H. pylori) disease (GERD) is controversial. In Asian populations, the prevalence of H. pylori infection is high and GERD is relatively uncommon. The aim of this study was 1) to test the hypothesis that H. pylori protects the esophagus against GERD, and 2) to study the pattern of H. pylori colonization and gastritis in GERD. METHODS: We conducted a prospective case-control study in which patients with GERD and asymptomatic controls were compared for the prevalence of H. pylori infection. Diagnosis of GERD was based on symptoms of heartburn that improved with acid-suppressive therapy and/or endoscopic evidence of erosive esophagitis. H. pylori status was determined by serology and, when endoscopy was indicated, was confirmed by rapid urease test and histology. Gastric biopsies were examined under hematoxylin and eosin and Giemsa stains. Density of H. pylori colonization and activity of gastritis at different parts of stomach were graded and compared according to Updated Sydney system. RESULTS: A total of 106 patients with GERD and 120 age- and sex-matched, asymptomatic controls were enrolled. The prevalence of H. pylori infection was significantly lower in GERD patients (31%) compared with controls (61%, p < 0.001, odds ratio 0.229, 95% confidence interval 0.13-0.41). H. pylori-infected GERD patients showed significantly more severe gastritis in the antrum than in other parts of stomach (mean inflammatory scores: antrum; 3.3 +/- 1.63*, body; 1.85 +/- 1.31; fundus; 1.65 +/- 0.58; cardia, 1.65 +/- 1.39; *p < 0.005). H. pylori colonization was found less commonly and at lower density at the cardia compared with other parts of the stomach. CONCLUSIONS: H. pylori infection protects against the development of GERD, and carditis is unlikely to play an important role.     

2020年中国胃食管反流病内镜治疗专家共识

胃食管反流病（gastroesophageal reflux disease, GERD）的内镜治疗逐渐流行,但目前缺乏应用的行业指导。为了规范GERD的内镜治疗,中国医师协会消化医师分会胃食管反流病专业委员会和中华医学会消化内镜学分会食管疾病协作组牵头,邀请国内相关领域专家对国内外有关文献进行检索、讨论,并召开了4次专家研讨会,制订了本专家共识。本专家共识涉及GERD的诊断、内镜治疗前评估、内镜治疗方式选择指导及效果评价,以及GERD内镜治疗后的管理和随访。     

Specialized columnar epithelium of the esophagogastric junction: prevalence and associations. The Central Finland Endoscopy Study Group

OBJECTIVES: In Barrett's esophagus (BE) normal squamous esophageal epithelium is replaced by specialized columnar epithelium (SCE). BE is related to gastroesophageal reflux disease (GERD) and is a risk factor for esophageal adenocarcinoma. SCE is detected also at normal-appearing esophagogastric junction without BE (junctional SCE). The relationships between junctional SCE, GERD, and cardia adenocarcinoma are obscure and controversial. The aims of the present study were to investigate the prevalence and demographics of junctional SCE and to compare these figures with those reported for BE, and esophageal and cardia adenocarcinoma. A further aim was to examine the association between junctional SCE and GERD, Helicobacter pylori infection, and gastritis. METHODS: One thousand one hundred-nineteen consecutive dyspeptic patients underwent gastroscopy and were enrolled into the study. RESULTS: Junctional SCE was detected in 110 patients (10%). The age-specific prevalence of junctional SCE increased with age. The male:female ratio was 1:1.1. In multivariate analysis, junctional SCE was independently and positively related to endoscopic erosive esophagitis (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-3.1), cardia inflammation (carditis) (OR, 3.1; 95% CI, 1.4-6.8), and age (OR, 1.4 per decade; 95% CI, 1.2-1.6), but not to corpus H. pylori infection (OR, 1.4; 95% CI, 0.7-2.8), antral (OR, 1.0; 95% CI, 0.5-2.1) or corpus (OR, 0.8; 95% CI, 0.4-1.8) gastritis, or intestinal metaplasia of the antral mucosa in stomach (OR, 1.2; 95% CI, 0.7-2.1). In univariate analysis, junctional SCE was, however, significantly more common in patients with antral-predominant atrophic gastritis (20%), compared with those with normal gastric histology (8%, p < 0.001). CONCLUSIONS: Junctional SCE is age related and may therefore be an acquired lesion. It is associated with cardia inflammation and endoscopic erosive esophagitis, but not with H. pylori infection or gastric intestinal metaplasia. Unlike BE and cardia cancer, junctional SCE occurs with similar frequency in men and women.     

Endoscopic therapy for gastroesophageal reflux disease

Endoscopic therapies aimed to reduce gastroesophageal reflux have gained an enormous enthusiasm during the last 5 years when several of them were approved by the regulatory agencies and released on the market. These novel therapies comprise 3 types of techniques: injection/bulking, plicating/suturing and radiofrequency thermal injury. Open-labelled trials performed on proton pump inhibitors-responding patients with typical gastroesophageal reflux disease (GERD) symptoms have shown an improvement in reflux symptoms during short term follow-up. Longer-term data are now available and show disappointing results with partial-thickness plications of the cardia. Randomized sham-controlled trials, which are essential to proof the efficacy of GERD endotherapy because of a known high placebo effect in the management of GERD patients, have been conducted, one with radiofrequency and one with polymer injection, and have confirmed the clinical efficacy of both techniques, although the clinical benefit was less impressive than suggested in open-labelled trials. While mechanistic studies have suggested that the compliance of the gastroesophageal junction might be altered by GERD endotherapy, objective assessment of acid reflux with ambulatory pH-metry has shown, however, minimal or no modification by the treatment. Concerns about the safety of these new techniques have raised when complications were reported as the number of treated cases increased. Currently, no definite indication is established for each technique, but numerous potential indications exist and should be addressed in the setting of carefully designed clinical trials. Physicians should be patient and wait for proof of efficacy and safety of these techniques before using them in their clinical practice. Specific and extensive warning should be obtained before starting clinical application. The present review aims to provide a comprehensive and critical view of endoscopic therapy in GERD management.     

Endoscopic full-thickness plication for the treatment of GERD: 12-month follow-up for the North American open-label trial

BACKGROUND: The aim of this study was to assess the intermediate-term (12-month) safety and efficacy of endoscopic full-thickness plication in patients with symptomatic GERD. METHODS: Sixty-four patients with chronic heartburn that required maintenance antisecretory therapy received a single, endoscopically placed, full-thickness plication in the gastric cardia 1 cm distal to the gastroesophageal junction. At baseline and 12 months after plication, patients completed the GERD Health Related Quality of Life questionnaire, Gastrointestinal Symptom Rating Scale, and SF-36 Health Survey, as well as a medication use diary. Ambulatory 24-hour pH monitoring and esophageal manometry were obtained at baseline and 3 months after plication. At 6 months after plication, the 24-hour pH study was repeated. RESULTS: Of the 57 patients who completed the 12-month follow-up, 40 (70%) were no longer taking a proton pump inhibitor. Median GERD Health Related Quality of Life scores were improved compared with baseline while taking medication (19.0 vs. 5.0; p < 0.0001) and while not taking medication (13.0 vs. 5.0; p < 0.002). At 6 months after the procedure, an improvement in distal esophageal acid exposure was demonstrated in 40 of 51 patients (80%), with a decrease of 39% in the median percentage of time the pH was less than 4 (p < 0.0001). Normal pH scores were observed in 30% of patients. All procedure-related adverse events occurred acutely, as previously reported, and no new adverse event was observed during extended follow-up. CONCLUSIONS: Full-thickness plication at the gastroesophageal junction is an effective endoscopic procedure for treatment of patients with symptoms caused by GERD. It reduces reflux symptoms and antisecretory medication use over at least a 1-year period.