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1.
Fundoplication improves disordered esophageal motility 总被引:4,自引:0,他引:4
T. Ryan Heider M.D. Kevin E. Behrns M.D. Mark J. Koruda M.D. Nicholas J. Shaheen M.D. Tananchai A. Lucktong M.D. Barbara Bradshaw R.N. Timothy M. Farrell M.D. 《Journal of gastrointestinal surgery》2003,7(2):159-163
Patients with gastroesophageal reflux disease (GERD) and disordered esophageal motility are at risk for postoperative dysphagia,
and are often treated with partial (270-degree) fundoplication as a strategy to minimize postoperative swallowing difficulties.
Complete (360-degree) fundoplication, however, may provide more effective and durable reflux protection over time. Recently
we reported that postfundoplication dysphagia is uncommon, regardless of preoperative manometric status and type of fundoplication.
To determine whether esophageal function improves after fundoplication, we measured postoperative motility in patients in
whom disordered esophageal motility had been documented before fundoplication. Forty-eight of 262 patients who underwent laparoscopic
fundoplication between 1995 and 2000 satisfied preoperative manometric criteria for disordered esophageal motility (distal
esophageal peristaltic amplitude ≤30 mm Hg and/or peristaltic frequency ≤80%). Of these, 19 had preoperative manometric assessment
at our facility and consented to repeat study. Fifteen (79%) of these patients had a complete fun-doplication and four (21%)
had a partial fundoplication. Each patient underwent repeat four-channel esophageal manometry 29.5 ± 18.4 months (mean ± SD)
after fundoplication. Distal esophageal peristaltic amplitude and peristaltic frequency were compared to preoperative data
by paired t test. After fun-doplication, mean peristaltic amplitude in the distal esophagus increased by 47% (56.8 ± 30.9 mm Hg to 83.5
± 36.5 mm Hg; P < 0.001) and peristaltic frequency improved by 33% (66.4 ± 28.7% to 87.6 ± 16.3%; P< 0.01). Normal esophageal motor function was present in 14 patients (74%) after fundoplication, whereas in five patients
the esophageal motor function remained abnormal (2 improved, 1 worsened, and 2 remained unchanged). Three patients with preoperative
peristaltic frequencies of 0%, 10%, and 20% improved to 84%, 88%, and 50%, respectively, after fundoplication. In most GERD
patients with esophageal dysmotility, fundoplication improves the amplitude and frequency of esophageal peristalsis, suggesting
refluxate has an etiologic role in motor dysfunction. These data, along with prior data showing that postoperative dysphagia
is not common, imply that surgeons should apply complete fun-doplication liberally in patients with disordered preoperative
esophageal motility.
Presented at the Forty-Third Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, California,
May 19–22, 2002 (poster presentation). 相似文献
2.
Shahin Ayazi Jessica M. Leers Arzu Oezcelik Emmanuele Abate Christian G. Peyre Jeffrey A. Hagen Steven R. DeMeester Farzaneh Banki John C. Lipham Tom R. DeMeester Peter F. Crookes 《Surgical endoscopy》2009,23(9):1968-1973
Background Ambulatory esophageal pH monitoring is the method used most widely to quantify gastroesophageal reflux. The degree of gastroesophageal
reflux may potentially be underestimated if the resting gastric pH is high. Normal subjects and symptomatic patients undergoing
24-h pH monitoring were studied to determine whether a relationship exists between resting gastric pH and the degree of esophageal
acid exposure.
Methods Normal volunteers (n = 54) and symptomatic patients without prior gastric surgery and off medication (n = 1,582) were studied. Gastric pH was measured by advancing the pH catheter into the stomach before positioning the electrode
in the esophagus. The normal range of gastric pH was defined from the normal subjects, and the patients then were classified
as having either normal gastric pH or hypochlorhydria. Esophageal acid exposure was compared between the two groups.
Results The normal range for gastric pH was 0.3–2.9. The median age of the 1,582 patients was 51 years, and their median gastric pH
was 1.7. Abnormal esophageal acid exposure was found in 797 patients (50.3%). Hypochlorhydria (resting gastric pH >2.9) was
detected in 176 patients (11%). There was an inverse relationship between gastric pH and esophageal acid exposure (r = −0.13). For the patients with positive 24-h pH test results, the major effect of gastric pH was that the hypochlorhydric
patients tended to have more reflux in the supine position than those with normal gastric pH.
Conclusion There is an inverse, dose-dependent relationship between gastric pH and esophageal acid exposure. Negative 24-h esophageal
pH test results for a patient with hypochlorhydria may prompt a search for nonacid reflux as the explanation for the patient’s
symptoms.
Presented orally at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Annual Meeting, Pennsylvania Convention
Center, Philadelphia, PA, USA, 9–12 April, 2008. 相似文献
3.
Background Abnormal esophageal body motility often accompanies gastroesophageal reflux disease (GERD). Although the effect of surgery
on the pressure and behavior of the lower esophageal sphincter (LES) has been extensively studied, it still is unclear whether
a successful fundoplication improves esophageal peristalsis.
Methods The pre- and postoperative esophageal manometries of 71 patients who underwent a successful laparoscopic fundoplication (postoperative
DeMeester score < 14.7) were reviewed. The patients were grouped according to the type of fundoplication (partial vs total)
and preoperative esophageal peristalsis (normal vs abnormal): group A (partial fundoplication and abnormal esophageal peristalsis;
n = 16), group B (total fundoplication and normal peristalsis; n = 41), and group C (total fundoplication and abnormal peristalsis; n = 14).
Results The LES pressure was increased in all the groups. A significant increase in amplitude of peristalsis was noted in groups A
and C. Normalization of peristalsis was achieved in 31% of the group A patients and 86% of the group C patients. No changes
occurred in group B.
Conclusions Laparoscopic fundoplication increased LES pressure and the strength of esophageal peristalsis in patients with abnormal preoperative
esophageal motility. A total fundoplication resulted in normalization of peristalsis in the majority of patients.
Presented at the Annual Meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Dallas, Texas,
27–29 April 2006 相似文献
4.
Christopher S. Davis Bernardino M. Mendez Diana V. Flint Karen Pelletiere Erin Lowery Luis Ramirez Robert B. Love Elizabeth J. Kovacs P. Marco Fisichella 《The Journal of surgical research》2013
Background
Aspiration of gastroesophageal refluxate has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF) and the progression of bronchiolitis obliterans syndrome after lung transplantation. The goals of the present study were to identify lung transplant patients at the greatest risk of aspiration and to investigate the causative factors.Materials and methods
From September 2009 to November 2011, 252 bronchoalveolar lavage fluid (BALF) samples were collected from 100 lung transplant patients. The BALF pepsin concentrations and the results of transbronchial biopsy, esophageal function testing, barium swallow, and gastric emptying scan were compared among those with the most common end-stage lung diseases requiring lung transplantation: IPF, chronic obstructive pulmonary disease, cystic fibrosis, and α1-antitrypsin deficiency.Results
Patients with IPF had higher BALF pepsin concentrations and a greater frequency of acute rejection than those with α1-antitrypsin deficiency, cystic fibrosis, or chronic obstructive pulmonary disease (P = 0.037). Moreover, the BALF pepsin concentrations correlated negatively with a lower esophageal sphincter pressure and distal esophageal amplitude; negatively with distal esophageal amplitude and positively with total esophageal acid time, longest reflux episode, and DeMeester score in those with chronic obstructive pulmonary disease; and negatively with the upright acid clearance time in those with IPF.Conclusions
Our results suggest that patients with IPF after lung transplantation are at increased risk of aspiration and a greater frequency of acute rejection episodes, and that the risk factors for aspiration might be different among those with the most common end-stage lung diseases who have undergone lung transplantation. These results support the role of evaluating the BALF for markers of aspiration in assessing lung transplant patients as candidates for antireflux surgery. 相似文献5.
Di Pace MR Caruso AM Catalano P Casuccio A Cimador M De Grazia E 《Journal of pediatric surgery》2011,46(3):443-451
Background
Gastroesophageal reflux (GER) and dysmotility are frequent in patients treated for esophageal atresia (EA). This aim of this study is to evaluate GER and dysmotility in young EA patients using pH-multichannel intraluminal impedance (pH-MII).Methods
Fifteen patients with a mean age of 7.5 years (group 1) have been studied and compared with 15 children without congenital malformation, submitted to pH-MII for suspected GER (group 2). These latter patients serve as a control group of healthy subjects. The following impedance reflux and motility parameters have been studied on 10 standardized swallows: number of reflux episodes, mean acid clearing time, median bolus clearing time, bolus presence time, total bolus transit time, segmental transit time, and total propagation velocity.Results
In the group of EA patients, mean acid clearing time and median bolus clearing time were pathological. In the control group, all reflux parameters were normal. Patients with EA had significantly longer median bolus presence time at each measuring site, median total bolus transit time, and median segmental transit time and slower total propagation velocity (P < .001).Conclusions
pH-multichannel intraluminal impedance evaluates both GER and motility patterns. Our report studies impedance parameters of esophageal motility in healthy children and in EA patients using only pH-MII. 相似文献6.
7.
Xenos ES 《Surgical endoscopy》2002,16(6):914-920
Background: The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial. This study evaluates the relationship
between esophageal exposure to acid, the presence or absence of a hiatal hernia, and manometric indicators of esophageal motility.
Methods: A total of 51 patients with foregut symptoms were evaluated with upper gastrointestinal series or endoscopy, 24-h
pH testing, and esophageal manometry. The DeMeester score was used to distinguish patients with physiologic reflux (DeMeester
score <14.72) FROM PATIENTS WITH PATHOLOGIC REFLUX (DEMEESTER SCORE >14.72). Results: Patients with physiologic reflux had
fewer hypotensive contractions and a smaller percentage of uncoordinated and hypotensive contractions combined, as compared
to patients with pathologic reflux. The amplitude of distal esophageal contractions was greater in patients with physiologic
reflux. Also, patients with a hiatal hernia had a higher incidence of pathologic reflux, regardless of the lower esophageal
sphincter pressure. Conclusion: Patients with pathologic reflux have abnormal acid exposure associated with pump failure of
the esophagus and/or a mechanical defect of the cardia associated with a hiatal hernia. 相似文献
8.
E Croce S Olmi M Golia R Russo 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2001,5(2):131-137
Gastroesophageal reflux disease has different clinical presentations that require different diagnostic and therapeutic approaches. This paper describes the appropriate use of diagnostic tests before and after treatment. Each diagnostic tool is examined from a practical point of view to determine the information it can provide and its possible pitfalls, and to comment on how it can influence therapeutic choices. Performing a preoperative diagnostic evaluation is especially stressed, so as not to select the wrong patient or the wrong procedure. Finally, failures of surgery are examined to understand their causes and to prevent them. The value of the most relevant examinations for diagnosing the causes of failures and choosing the appropriate solution are discussed. 相似文献
9.
Gasper WJ Sweet MP Hoopes C Leard LE Kleinhenz ME Hays SR Golden JA Patti MG 《Surgical endoscopy》2008,22(2):495-500
Background Gastroesophageal reflux disease (GERD) is prevalent among patients with end-stage lung disease (ESLD). This disease can lead
to microaspiration and may be a risk factor for lung damage before and after transplantation. A fundoplication is the best
way to stop reflux, but little is known about the safety of elective antireflux surgery for patients with ESLD. This study
aimed to report the safety of laparoscopic fundoplication for patients with ESLD and GERD before or after lung transplantation.
Methods Between January 1997 and January 2007, 305 patients were listed for lung transplantation, and 189 patients underwent the procedure.
In 2003, routine esophageal studies were added to the pretransplantation evaluation. After the authors’ initial experience,
gastric emptying studies were added as well.
Results A total of 35 patients with GERD or delayed gastric emptying were referred for surgical intervention. A laparoscopic fundoplication
was performed for 32 patients (27 total and 5 partial). For three patients, a pyloroplasty also was performed. Two patients
had a pyloroplasty without fundoplication. Of the 35 operations, 15 were performed before and 20 after transplantation. Gastric
emptying of solids or liquids was delayed in 12 (92%) of 13 posttransplantation studies and 3 (60%) of 5 pretransplantation
studies. All operations were completed laparoscopically, and 33 patients recovered uneventfully (94%). The median hospital
length of stay was 2 days (range, 1–34 days) for the patients admitted to undergo elective operations. Hospitalization was
not prolonged for the three patients who had fundoplications immediately after transplantation.
Conclusions The results of this study show that laparoscopic antireflux surgery can be performed safely by an experienced multidisciplinary
team for selected patients with ESLD before or after lung transplantation, and that gastric emptying is frequently abnormal
and should be objectively measured in ESLD patients.
Presented as a Poster of Distinction at the Spring 2007 Meeting of the Society of Gastrointestinal and Endoscopic Surgeons
(SAGES) at Las Vegas, Nevada, 18–22 April 2007 相似文献
10.
Di Pace MR Caruso AM Farina F Casuccio A Cimador M De Grazia E 《Journal of pediatric surgery》2011,46(10):1881-1886
Background
Gastroesophageal reflux (GER) is frequently observed in children treated for congenital diaphragmatic hernia (CDH) at birth, as well as esophageal dysmotility, that has been hypothesized to be caused by innervatory anomalies. The aim of this study is to evaluate GER and dysmotility in young patients with CDH using pH-multichannel intraluminal impedance.Methods
Thirty children (17 boys and 13 girls) who underwent repair for CDH between 2002 and 2007 with a median age of 5.2 years (range, 3-10 years) were included in the study. All patients were operated on with a subcostal laparotomy incision and had a left-sided diaphragmatic defect. The defect repair required an artificial patch (Goretex, Gore Medical, Flagstaff, AZ) in 8 patients (27%) because of its size. We described impedance reflux parameters and some specific motility parameters studied on 10 standardized swallows.Results
The incidence of GER was 86%. Reflux was mainly nonacidic, postprandial, and short-term and reached only the distal esophagus. Esophageal dysmotility was observed only in the distal esophagus.Conclusions
With the use of pH-multichannel intraluminal impedance, both GER and esophageal motility in patients with congenital malformations can be analyzed. In patients with CDH, impaired motility seems to involve only the distal esophagus. In this group, the specific pattern of reflux is probably caused by the involvement of gastroesophageal junction, without significant intrinsic innervation abnormalities as observed in patients with esophageal atresia. 相似文献11.
Piero Marco Fisichella Nicholas P. Reder James Gagermeier Elizabeth J. Kovacs 《The Journal of surgical research》2014
Background
Patients with scleroderma and end-stage lung disease (ESLD) have a very high prevalence of gastroesophageal reflux disease (GERD). Because GERD has been associated with aspiration in those with ESLD, and because those with scleroderma are particularly prone to develop severe GERD, there is some concern that GERD may contribute to shorten survival in patients with scleroderma awaiting lung transplantation. Therefore, we hypothesized that esophageal pH monitoring could predict survival of those with scleroderma and ESLD awaiting lung transplantation and that the severity of reflux can impact survival.Methods
We conducted a retrospective analysis of all scleroderma patients referred for lung transplantation who underwent esophageal manometry and pH monitoring since August 2008. We identified 10 patients in whom we calculated and compared the area under the curve for each receiver operating characteristic curve of the following variables: DeMeester score, forced expiratory volume in 1 s (FEV1), %predicted FEV1, forced vital capacity (FVC), %predicted FVC, diffusion capacity for carbon monoxide (DLco), and %predicted DLco.Results
The DeMeester score nominally outperformed FEV1, FVC, and DLco. Receiver operating characteristic curve analysis was also used to define the optimal DeMeester score (65.2) in differentiating survival status, as determined by maximizing sensitivity and specificity. Based on this value, we calculated the 1-y survival from the time of the esophageal function testing, which was 100% in seven patients with a DeMeester score of <65.2, and 33% in three patients with a score >65.2 (P = 0.01). The latter patients had greater total time pH < 4, greater time pH < 4 in the supine position, greater total episodes of reflux, and higher prevalence of absent peristalsis. The single survivor with a DeMeester score >70 had also proximal reflux, underwent antireflux surgery, and is alive 1201 d after transplant.Conclusions
Our study shows that esophageal pH monitoring can predict survival status in patients with scleroderma awaiting lung transplantation and that the severity of reflux can impact the 1-y survival rate. Therefore, esophageal pH monitoring should be considered early in patients with scleroderma and ESLD, as this test could appropriately identify those in whom laparoscopic antireflux surgery should be performed quicker to prevent GERD and its detrimental effects in patients awaiting lung transplantation. 相似文献12.
Changes in GERD symptom scores correlate with improvement in esophageal acid exposure after the Stretta procedure 总被引:2,自引:0,他引:2
Triadafilopoulos G 《Surgical endoscopy》2004,18(7):1038-1044
Background Endoscopic radiofrequency energy delivery (Stretta) is effective for managing gastroesophageal reflux disease (GERD) in selected patients. One criticism, however, is a theory that a mechanism of action is partial desensitization of the esophageal body rather than a reduction in esophageal acid exposure. To resolve this question, this study sought to determine if there is a correlation between the improvement in GERD outcomes and esophageal acid exposure after Stretta.Methods Subgroup analyses were performed between responder and nonresponder groups from the U.S. Stretta open label trial (n = 118), on the basis of posttreatment responses for GERD health-related quality of life (HRQL) heartburn, satisfaction, and proton pump inhibitor use. Outcomes were analyzed within and between subgroups. Pearson correlation coefficient analysis was performed comparing distal esophageal acid exposure with each of the continuous outcomes (GERD-HRQL, heartburn, satisfaction).Results Responder subgroups had significant improvements in esophageal acid exposure, whereas nonresponders had no change or less improvement in the same. Changes in GERD-HRQL and heartburn severity were correlated with changes in acid exposure (r = 0.16, p = 0.12 and r = 0.26, p = 0.01, respectively). Changes in satisfaction were negatively correlated with changes in esophageal acid exposure (r = 0.23, p = 0.02) because satisfaction, as expected, increased as acid exposure decreased.Conclusions Responders had significant improvement in esophageal acid exposure, whereas nonresponders had less or no change. There was a positive correlation between esophageal acid exposure and both GERD-HRQL and heartburn. This evidence suggests that symptomatic improvement after Stretta is attributable to a decrease in esophageal acid exposure and not to desensitization of the esophagus. 相似文献
13.
14.
Winslow ER Clouse RE Desai KM Frisella P Gunsberger T Soper NJ Klingensmith ME 《Surgical endoscopy》2003,17(5):738-745
Background: The clinical outcomes of laparoscopic antireflux surgery (LARS) in patients with the spectrum of nonspecific spastic esophageal motor disorders (NSSDs) are not known. Methods: From a prospective database of patients undergoing LARS between 1997 and 2000, those with preoperative manometry at our institution and follow-up at 6 months were identified. Results: Of the 121 patients, 35 had NSSDs. There were no differences in symptoms between groups preoperatively, but in the immediate postoperative period NSSD patients had more symptoms than nonspastic patients. At 18-month mean follow-up, NSSD patients reported significantly more heartburn (22% vs 7%), waterbrash (14% vs 4%), and medication usage (17% vs 5%) than nonspastic patients (p < 0.05 for each). Despite this difference, nearly all patients reported subjective improvement postoperatively, and the degree of improvement was similar between groups. Conclusions: Patients with NSSDs are more likely to have esophageal symptoms following LARS than subjects without these abnormalities. However, these patients still experience significant improvement in preoperative symptoms.
Presented at the 8th World Congress Society of American Gastrointestinal Endoscopic Surgeons (SAGES). New York, NY, USA, March 2002 相似文献
15.
目的总结采用管状胃的食管癌手术患者的术后反流情况,探讨管状胃宽度对食管癌切除术后胃食管反流的影响。
方法前瞻性地按照入院顺序,将60例食管癌术中采用管状胃代食管的患者按管状胃裁制宽度是否大于3 cm,随机分为A组30例(管状胃宽度≥3 cm)和B组30例(管状胃宽度<3 cm),分别在术后11~14 d胃肠功能恢复后使用pH监测仪进行24 h食管pH值监测。
结果A组反流次数、反流超过5 min的次数、pH值<4.00的总时间和最长反流时间均多于B组(t=2.735,P=0.012;t=4.502,P=0.001;t=3.435,P=0.023;t=4.286,P=0.002)。
结论管状胃宽度影响反流的发生,细的管状胃可减轻食管癌术后反流的发生。 相似文献
16.
17.
Shahin Ayazi Jeffrey A. Hagen Linda S. Chan Steven R. DeMeester Molly W. Lin Ali Ayazi Jessica M. Leers Arzu Oezcelik Farzaneh Banki John C. Lipham Tom R. DeMeester Peter F. Crookes 《Journal of gastrointestinal surgery》2009,13(8):1440-1447
Introduction Obesity and gastroesophageal reflux disease (GERD) are increasingly important health problems. Previous studies of the relationship
between obesity and GERD focus on indirect manifestations of GERD. Little is known about the association between obesity and
objectively measured esophageal acid exposure. The aim of this study is to quantify the relationship between body mass index
(BMI) and 24-h esophageal pH measurements and the status of the lower esophageal sphincter (LES) in patients with reflux symptoms.
Methods Data of 1,659 patients (50% male, mean age 51 ± 14) referred for assessment of GERD symptoms between 1998 and 2008 were analyzed.
These subjects underwent 24-h pH monitoring off medication and esophageal manometry. The relationship of BMI to 24-h esophageal
pH measurements and LES status was studied using linear regression and multiple regression analysis. The difference of each
acid exposure component was also assessed among four BMI subgroups (underweight, normal weight, overweight, and obese) using
analysis of variance and covariance.
Results Increasing BMI was positively correlated with increasing esophageal acid exposure (adjusted R
2 = 0.13 for the composite pH score). The prevalence of a defective LES was higher in patients with higher BMI (p < 0.0001). Compared to patients with normal weight, obese patients are more than twice as likely to have a mechanically defective
LES [OR = 2.12(1.63–2.75)].
Conclusion An increase in body mass index is associated with an increase in esophageal acid exposure, whether BMI was examined as a continuous
or as a categorical variable; 13% of the variation in esophageal acid exposure may be attributable to variation in BMI.
An erratum to this article can be found at 相似文献
18.
S. Ayazi J. C. Lipham J. A. Hagen A. L. Tang J. Zehetner J. M. Leers A. Oezcelik E. Abate F. Banki S. R. DeMeester T. R. DeMeester 《Journal of gastrointestinal surgery》2009,13(8):1422-1429
Introduction Identifying gastroesophageal reflux disease as the cause of respiratory and laryngeal complaints is difficult and depends
largely on the measurements of increased acid exposure in the upper esophagus or ideally the pharynx. The current method of
measuring pharyngeal pH environment is inaccurate and problematic due to artifacts. A newly designed pharyngeal pH probe to
avoid these artifacts has been introduced. The aim of this study was to use this probe to measure the pharyngeal pH environment
in normal subjects and establish pH thresholds to identify abnormality.
Methods Asymptomatic volunteers were studied to define the normal pharyngeal pH environment. All subjects underwent esophagram, esophageal
manometry, upper and lower esophageal pH monitoring with a dual-channel pH catheter and pharyngeal pH monitoring with the
new probe. Analyses were performed at 0.5 pH intervals between pH 4 and 6.5 to identify the best discriminating pH threshold
and calculate a composite pH score to identify an abnormal pH environment.
Results The study population consisted of 55 normal subjects. The pattern of pharyngeal pH environment was significantly different
in the upright and supine periods and required different thresholds. The calculated discriminatory pH threshold was 5.5 for
upright and 5.0 for supine periods. The 95th percentile values for the composite score were 9.4 for upright and 6.8 for supine.
Conclusion A new pharyngeal pH probe which detects aerosolized and liquid acid overcomes the artifacts that occur in measuring pharyngeal
pH with existing catheters. Discriminating pH thresholds were selected and normal values defined to identify patients with
an abnormal pharyngeal pH environment.
This work has been presented at the Digestive Disease Week, San Diego, California, May, 2008.
The study was supported by a grant from the Respiratory Technology Corp. T.R. DeMeester is on the scientific advisory board
of Respiratory Technology Corp. 相似文献
19.
经食管床胃食管吻合术后胃食管反流与胃排空的临床研究 总被引:1,自引:0,他引:1
目的 客观评价食管中段癌切除经食管床主动脉弓上胃食管吻合术对术后胃食管反流和胃排空的影响。方法 将40例食管中段癌患者随机分成两组,食管床吻合组(n=20):采用经食管床主动脉弓上胃食管吻合术;左胸腔内吻合组(n=20):采用经左侧胸腔主动脉弓前胃食管吻合术;另选10名无消化系统疾病的健康志愿者作为正常对照组。于术后3个月进行24h食管pH监测,放射性核素胃排空检查,观察术后胃食管反流和胃排空情况。结果 所有患者手术均成功,无手术死亡,术后无吻合口漏和狭窄。术后3个月左胸腔内吻合组和食管床吻合组患者均有不同程度的反流,DeMeester总评分、24h酸反流次数、〉5min的反流次数、最长反流持续时间、pH(4.00的总时间和pH(4.00占总时间的百分比均高于正常对照组(P〈0.01);食管床吻合组DeMeester总评分、24h酸反流次数、最长反流持续时间、pH(4.00的总时间、pH(4.00占总时间的百分比均低于左胸腔内吻合组(P〈0.01)。术后近期各时间段左胸腔内吻合组和食管床吻合组胃排空百分数(GE)均较正常对照组低(P〈0.01);食管床吻合组GE于实验餐进入胃后30、60、90、120、180和240min均高于左胸腔内吻合组(P〈0. 01)。结论经食管床主动脉弓上吻合术后胃食管反流和胃排空延迟客观存在,但较传统手术方式有所减轻,其机制可能是机械因素所致。 相似文献
20.
Evaluation of gastroesophageal reflux disease following various reconstructive procedures for a distal gastrectomy 总被引:2,自引:0,他引:2
Background and aims Some patients develop gastroesophageal reflux disease (GERD) after a distal gastrectomy. In these patients, the evaluation of GERD with 24-h pH monitoring could be difficult because they may have an insufficient amount of gastric acid.Patients and methods To evaluate GERD following a distal gastrectomy, we retrospectively evaluated 38 patients postoperatively with an acid reflux test (ART), a barium study, endoscopy, and esophageal manometry. Three reconstructive procedures, Billroth I (B-I group: 14 patients), Billroth II (B-II group: 11 patients), and jejunal interposition (interposition group: 13 patients) were compared with respect to GERD and short- term operation results.Results Operation time and postoperative hospital stay were longest in the interposition group. Reflux symptoms were present in ten patients (26%). The ART, barium study and endoscopy demonstrated evidence of GERD in 22 (58%), 10 (26%) and 4 (11%) of the 38 patients, respectively. The frequency of a positive ART in the interposition group was significantly lower than in both the B-I and the B-II groups. The abdominal length of the lower esophageal sphincter in the interposition group was higher than that in the B-II group (P<0.05).Conclusion Although jejunal interposition required longer operation time and hospital stay, the lower esophageal sphincter function following jejunal interposition appears to be superior to that following a Billroth-I or Billroth-II procedure. 相似文献