消化内镜手术构建食管抗返流屏障治疗犬胃食管返流病效果观察

目的 研究消化内镜手术构建食管抗返流屏障治疗犬胃食管返流病的效果.方法 本研究起止时间为2015年1月至2016年7月,于东华医院消化科应用消化内镜"隧道式"方法剥离食管黏膜并切断食管下段环状肌,制造犬胃食管返流病模型共30只,根据随机数字表法均分为内镜治疗组和药物治疗组,每组15只.内镜治疗组应用消化内镜在胃腔内胃食管交界处手术构建抗返流瓣,药物治疗组应用质子泵抑制剂服药治疗,比较内镜手术治疗和药物治疗对犬胃食管返流病的治疗效果.结果 内镜治疗组括约肌长度为(2.63±0.43)cm、食管下段括约肌压力为(2.26±0.30)kPa、松弛率为(30.47±6.11)%,明显高于药物治疗组的(1.89±0.42)cm、(1.93±0.38)kPa、(24.75±3.85)%,内镜治疗组的pH<4总时间为(1.03±0.33)h、pH<4监测返流次数(18.46±4.20)次、pH<4返流持续时间>5 min的次数为(2.47±1.36)次,均低于药物治疗组的(1.59±0.42)h、(25.69±3.20)次、(24.75±3.85)次,上述各项指标比较差异均具有统计学意义(P<0.05);内镜治疗组钡剂返流率为6.67%,钡剂清除率为0,均小于药物治疗组的20%和20%,差异均有统计学意义(P<0.05).结论 应用消化内镜手术构建食管抗返流屏障治疗犬胃食管返流病疗效显著,可以为临床胃食管返流病的治疗提供借鉴.

Effect of esophageal anti-reflux barrier by digestive endoscopic surgery in treatment of gastroesophageal reflux disease in dogs

Objective To study the effect of esophageal anti-reflux barrier by endoscopic surgery in treatment of gastroesophageal reflux disease (GERD) in dogs. Methods A total of 30 dog models with GERD which applied di-gestive endoscopy "tunnel" method of peeling to remove the esophageal mucosa and cut off the esophageal circular muscle in Department of Gastroenterology in Donghua Hospital from January 2015 to July 2016 were established. They were divided into two groups:endoscopic treatment group and drug treatment group, according to the random number table, with 15 dogs in each group. Endoscopic treatment group applied digestive endoscopy in gastric cavity gastro-esophageal junction surgery to construct anti-reflux valve, and the drug group was treated with proton pump inhibitor medication. The treatment effect of endoscopic surgical treatment and drug treatment on GERD in dogs was compared. Results The length of the sphincter, lower esophageal sphincter pressure, relaxation rate were respectively (2.63 ± 0.43) cm, (2.26±0.30) kPa, (30.47±6.11)%in endoscopic treatment group, which were significantly higher than those in drug treatment group of (1.89±0.42) cm, (1.93±0.38) kPa, (24.75±3.85)%. The total time of pH<4, monitor reflux num-ber of pH<4, reflux duration>5 minutes of pH<4 were respectively (1.03±0.33) h, (18.46±4.20) beats, (2.47±1.36) beats in endoscopic treatment group, which were significantly lower than those in drug treatment group of (1.59 ± 0.42) h, (25.69±3.20) beats, (24.75± 3.85) beats (P<0.05). The barium regurgitation rate (6.67%) and barium clearance rate (0) in endoscopic treatment group were less than those in the drug group (20%and 20%), P<0.05. Conclusion Construction of esophageal anti-reflux barrier by endoscopic surgery has significant effect in treatment of gastroesophageal reflux dis-ease in dogs, which can provide reference for clinical treatment of GERD.