Clinical Study On Minimally Invasive Treatment Of Gastroesophageal Reflux Disease

Background:Gastroesophageal reflux disease(GERD) is composed of a number of factors contributed to the power of upper gastrointestinal tract disorder, is in the stomach into the esophagus, causing a series of symptoms of esophagus and esophageal complications.Laparoscopic minimally invasive surgery in the treatment of GERD showed advantage gradually, the existence of a variety of surgical methods, such as: laparoscopic Nissen gastric folds, Toupet gastric folds and are stomach bottom folded, each have advantages and disadvantages, but their application scope is not clear at present, there is no standard treatment system, domestic for the systemic treatment of the disease in the exploration stage, has not yet formed for the treatment of GERD specification guidelines to guide clinical work.Objective:Through to the tianjin nankai hospital in April 2011- March 2014 minimally invasive treatment of gastroesophageal reflux disease were analyzed, and the comparison of different laparoscopic gastric folding the curative effect of surgery treatment, to different extent, different age gastroesophageal reflux disease stomach bottom folding line laparoscopic surgery, treatment of gastroesophageal reflux disease in the future provide the feasibility of standardized treatment.Method:Prospective studies in April 2011- March 2014 in tianjin nankai hospital for treatment of gastroesophageal reflux disease, according to the American society of gastrointestinal endoscopy surgeon working guide and gastroesophageal reflux disease consensus standards in China and Demeester score choice, choose 276 cases of patients, according to the patients with different severity, age, and treatment group.Laparoscopic Nissen stomach bottom folding technique in 92 cases, laparoscopic Toupet stomach bottom fold surgery surgery in 92 cases, 92 cases of laparoscopic surgery are.All three types of minimally invasive surgery way hand preoperative, gastroscope, esophageal dynamics and 24 h after esophageal p H monitoring, and follow-up rating evaluation survey system.Result:Postoperative follow-up of 3-45 months, an average of 21±1.8 months, three kinds of operation both increase and improve the function of esophageal sphincter under 24 h, pressure and esophageal p H monitoring parameters, with each group after heartburn, reflux, retrosternal pain, acid reflux scores were significantly lower, the difference was statistically significant.Severe middle-aged Nissen surgery group to improve the most significant, heartburn ratings from 8.1±1.1 preoperatively to 0.9 ±0.4, satisfaction score was 9.1 ±0.7, compared with other groups statistically significant.Moderate middle age group, the severe elderly group with Toupet, improve the most significant are surgery, postoperative acid reflux, heartburn symptoms improved significantly and the degree of difficulty swallowing.Moderate elderly group in order to improve the most significant are surgery, postoperative follow-up rating system evaluation is higher, heartburn ratings from 6.2 ±1.1 preoperatively to 2.0 ±1.3, satisfaction score was 9.1 ±1.4, the other group was statistically difference, but there is a recurrence.Conclusion:Three kinds of laparoscopic gastric folding technique can effectively reduce gastroesophageal reflux, but need to select suitable operation.The lower esophagus and esophageal sphincter function in patients with preoperative assessment, esophageal motor function, for age < 65 years of age, preoperative esophageal p H monitoring confirmed severe stomach- 24 h esophageal reflux(Demeester score > 100) and the esophageal pressure effectively at all showed esophageal motor function implementation Nissen stomach bottom fold surgery;For age < 65, preoperative examination confirmed the moderate- esophageal reflux(Demeester score is between 50-100), or age 65 or higher, preoperative esophageal p H monitoring confirmed severe stomach- 24 h in patients with esophageal reflux(Demeester score > 100) implementation Toupet stomach bottom fold surgery;For aged 65 or higher, preoperative examination confirmed the moderate- esophageal reflux(De Meester score is between 50-100), or esophageal motor function memory implementation are stomach bottom fold.By selecting different operation to ensure the long-term effective anti reflux effect, and reduce postoperative complications.