内镜缝合术在反流性食管炎中临床应用探究.docVIP

内镜缝合术在反流性食管炎中临床应用探究 　 作者：王炳周，吴灵飞，罗碧芳 【关键词】 内镜缝合术；反流性食管炎 　　摘要：目的:探讨内镜缝合术在反流性食管炎中的应用价值及该术的安全性。方法：对经内镜、食管ph鉴测、食管测压、临床症状等确诊并且有质子泵抑制剂依赖的11例胃食管反流病(其中贲门切除术后胃食管反流2例)，应用美国BARD内镜缝合系统行内镜下贲门缝合术，观察术前术后胃食管反流的积分情况及该术的并发症等项目，对该术的短期疗效及安全性进行评价。结果：11例患者共缝合26针，13个结，其中纵行缝合4例次，环行缝合9例次。术后症状完全缓解的5例，部分缓解的4例，无效2例。除术中缝合处针孔少许渗血外，术中及术后患者均未出现明显并发症。结论：内镜缝合术近期疗效可靠，安全性好，远期疗效有待进一步研究。 　　关键词：内镜缝合术；反流性食管炎 　　Endoscopic Suturing Therapy for Gastroesophageal Reflux Disease 　　Abstract: Objective: This study was to evaluate prospectively the feasibility and efficacy of endoscopic suturing therapy for gastroesophageal reflux disease. Method: The study involved 9 patients with gastroesophageal reflux disease (GERD) that required proton pump inhibitor (PPI) treatment, including 2 patients with resection of cardiac orifice．Using BARD Endoscopic Suturing Device, plications were created at the gastroesophageal junction. Patients underwent endoscopy, 24-hour pH monitoring and esophageal manometry before treatment and 3 months afterwards. In addition, reflux symptoms as well as quality-of-life scores were assessed. Result: Thirteen procedures were finished in eleven patients. The p1icae were sutured on the lesser curve with linear configuration in 4 patients，around the cardiac with circumferential configuration in 9 cases. The heart burn and regurgitation were significant changes in 5 patients and remitted partly in 4 cases. The procedure was performed successfully in all patients without major complications except. Conclusion: Endoscopic suturing therapy for gastroesophageal reflux disease is an easy and safe treatment. Its initial results have been promising, the long-term durability of the treatment is uncertain. 　　Key words:Endoscopic suturing;GERD 　　部分反流性食道炎经内科治疗郊果不佳，常需依赖质子泵抑制剂治疗，患者经济上支出较大，且长期依赖药物可致一系列副作用，给患者造成巨大痛苦。该病患者常有贲门松驰，胃液易反流入食道，以往部分病例常需行外科手术治疗。内镜缝合术是利用特制的内镜缝合系统，即巴德内镜缝合系统（bard endocinch），于内镜下进行贲门粘膜缝合以代替外科的胃底折叠术，从而达到缩小贲门，防止胃食管反流的作用。该方法相对于手术来说操作简单，费用低，且缝合术为可逆，缝合以后如有不适可拆除缝线。我们自2002年9月以来对11例反流性食管炎行内镜缝合术，治疗效果