胃食管喉气管综合征(GELTS)的发现与命名——Stretta射频治疗胃食管反流病200例

目的:探讨胃食管反流病(gastroesophageal reflux disease,GERD)临床表现和内镜下Stretta射频治疗效果。方法:对2006年4月~2007年2月施行内镜下射频治疗的200例GERD临床资料及随访情况进行分析。结果:200例中49例以反酸、烧心、咽部异物感等消化道症状为主;36例仅表现为咳嗽、咯痰、喘息、憋气等呼吸道症状;98例以消化道表现为主合并呼吸道症状;15例以呼吸道症状为主,偶有消化道症状;2例表现为胸骨后疼痛,诊为冠心病。治疗后即刻复查胃镜见190例贲门口包绕内镜紧密,10例贲门口较前缩紧;4例术中食管、贲门黏膜少量出血,无其他并发症。治疗2天内198例症状消失或明显缓解。随访1~11个月,5例自觉无明显改善,3例于术后1~7个月后复发(1例接受了重复治疗,“哮喘”再度消失),12例失访;180例(90.0%)症状消失或明显改善,以呼吸道症状为主者尤其明显。结论:GERD导致的呼吸道和咽喉部表现既常见凶险,又罕为大众所知,为此作者提出了以胃食管交接处为启动器、以咽为反应器、以口鼻为效应器、以喉气管为喘息发生器所引起的一系列临床表现,称为胃食管喉气管综合征(gastroesphago-larygotracheal syndrome,GELTS)或两管一腔综合征这一新概念。内镜下Stretta治疗GERD操作较为简捷、安全,具有颇好前景,更适于有严重呼吸道症状和GELTS的病例。复发时尚可重复治疗或改用手术治疗。

Discovery and Denomination of Gastroesphago-larygotracheal Syndrome(GELTS)-Summing-up on Treating 200 GERD Patients with Stretta Radiofrequency

Objective:Exploring the clinical presentations and efficacy of the Stretta radiofrequency treatment under endoscope for patients with gastroesophageal reflux disease(GERD).Methods:To analyze material of 200 patients with GERD who had been treated by Stretta radiofrequency.Results:49 patients with mainly acid reflux and heartburn;36 patients predominant had respiratory distresses,mostly diagnosed as asthma;98 had more digestive presentations and less respiratory ones;15 had more respiratory symptoms and less digestive ones;2 patients misdiagnosed as coronary disease.The follow-up was from 1-11 months,5 patients felt no marked improvement;3 had recurrences 1-7 months after treatment(one among them had a redo resulted in an immediate disappearance of "asthma");12 lost follow-up;180 patients had a disappearance of symptoms or a remarkable improvement,especially for those with respiratory distresses.Conclusion:The respiratory and laryngopharynx presentations caused by GERD are not only common and risky,but also rarely known by public,the author thus raised a new concept of gastroesophago-laryngotracheal syndrome or GELTS or one cavity two tract syndrome,which is characteristic of gastroesophageal junction as the generator,pharynx the reactor,nose-oral cavity the effector,larynx and respiratory tract the asthmatic producer.The Stretta radiofrequency is a relatively simple,safe and none-invasive to treat patients with GERD,especially proper for those with respiratory distresses.If recurrence occurs,the procedure can be repeated or other surgical procedures may also be installed.