| BackgroundGastroesophageal reflux disease(GERD),as a common chronic intestinal disease,has a sufficient incidence and recurrence rate.Patients often require repeated treatment after illness and have a longer treatment period and a serious psychological and financial burden.The main clinical symptoms of the patient are upper abdominal fullness,acid reflux,heartburn,pain,etc.,and even more,canceration occurs directly.From the 1990 s to the present,laparoscopic surgery has been improved.Among them,minimally invasive anti-reflux surgery has greatly reduced the hospitalization time and the incidence of complications.In recent years,fundoplication and esophageal hernia repair have been widely used in the treatment of gastroesophageal reflux disease and the effect is obvious.The repair of esophageal hiatus hernia is a surgical procedure for suturing the patient's esophageal hiatus hernia,first suturing the patient's esophageal hiatus,and then giving the patch repair surgery.But fundoplication is a procedure that involves wrapping the fundus around the circumference.It mainly includes Toupet270° and Nissen360°.At present,there is some controversy about the clinical safety and effectiveness of these two methods and the treatment of the disease with this surgical method.Based on this,this paper carried out the evaluation of the satisfaction of postoperative patients in patients with drug therapy and the effect of esophageal hiatal hernia repair and laparoscopic fundoplication in the clinical application process.The purpose of this study was to provide patients with a safe and effective method for the treatment of gastroesophageal reflux disease,to assist patients with improved prognosis.ObjectiveTo compare the efficacy of drug therapy and surgical treatment in patients with gastroesophageal reflux disease(GERD)and to evaluate the clinical effects of laparoscopic fundus folding and repair of esophageal hiatus hernia.Methods(1)The study subjects were diagnosed as having gastroesophageal reflux disease in 92 patients who underwent esophageal hernia repair and laparoscopic fundoplication during the period from May 2009 to August 2016.Before the operation,the patients were divided into three groups according to the medication,the medication was more than 30 months and not more than 60,and the medication was more than 60 months.The patient satisfaction before and after the operation and the preoperative medication duration were evaluated.influences;According to the difference of patients with laparoscopic fundoplication,they were divided into two groups,Toupet and Nissen.The number of patients was 38 and 54 respectively.Nissen 360° was used in the Nissen group and Toupet 270° in the Toupet group.The postoperative recovery,postoperative symptom relief,use of surgical satisfaction patch,preoperative drug use and postoperative dysphagia were compared between the two groups.Patients who took the drug before surgery were treated four weeks after the drug was stopped to elute the drug effect.ResultsThe scores of Visick scores in the two groups were higher than those before surgery,while the proportions of III~IV were lower than those before surgery(P<0.05).The symptomatic remission rate in the Nissen group was 77.78%(42/54),which was statistically significant compared with 63.16%(24/38)in the Toupet group(P<0.05).The satisfaction rate of Nissen group was 92.59%(50/54),which was not significantly different from that of Toupet group(81.57%(31/38))(P>0.05).Of the 57 patients with GERD who had good PPI reactivity,50 were in the Visick grade I and II,accounting for 87.7%.Among the 35 patients with poor PPI reactivity,the postoperative Visick grade I and II were There are 22 people,accounting for 62.8%.It can be found that patients with high PPI sensitivity have better anti-reflux surgery(P<0.05).Taking the drug for 30 months and 60 months as the boundary,the effect of PPI use time against reflux surgery was found to be taken.<=30 months,postoperative patient satisfaction was 89.6%,30< medication <=60,postoperative patient satisfaction Degree 88.8%,medication >60 months,postoperative patient satisfaction was 61.1%,postoperative satisfaction was statistically significant(P<0.05),followed by pairwise comparison found that medication <= 30 months group postoperative satisfaction There was no significant difference between the group of 30 < medication group <= 60 group and medication group > 60 group(p < 0.05),30 < medication group <= 60 group and medication group > 60 groups(p> 0.05).The results showed that the incidence of swallowing in the Nissen group and the Toupet group was 46.29% and 23.68%,respectively,within 1 month after surgery,and the differences were significant between the groups.However,the incidence of swallowing in patients within 6 months after surgery was 18.51% and 15.78%,and there was no significant difference between the groups.ConclusionEsophageal hernia repair and laparoscopic fundoplication for gastroesophageal reflux disease have a certain effect on the improvement of patients' condition,and their clinical safety is also guaranteed.Nissen360° can be selected according to the specific condition of the patient or Toupet 270° surgical treatment,preoperative use of PPI and sensitivity to the efficacy of PPI drugs,have a guiding significance for the choice of surgery. |
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