Miguel P R, Moreira da Rosa A L, Reusch M, Aguzzoli M
Service of Laparoscopic Surgery, Hospital Mãe de Deus, Porto Alegre, RS, Brazil.
JSLS. 1999 Jul-Sep;3(3):197-201.
Laparoscopic and thoracoscopic techniques have provided a new dimension in the correction of functional disorders of the esophagus. Therapeutic success, however, depends on the confirmation of esophageal disease as a cause of the symptoms, on understanding the basic cause of dysfunction and on identifying the surgical patient. This study is a retrospective study of patients submitted to surgery using the Lind procedure for gastroesophageal reflux disease (GERD). The purpose of this study is to establish the value of the routine use of esophageal manometry and 24-hour pH monitoring in order to select patients and perform pre and postoperative functional evaluation. Forty-one patients (68.3%) had a hypotonic lower esophageal sphincter. The average pressure was 9.2 mm Hg preoperatively and 15.2 mm Hg postoperatively, with an increase of 6.0 mm Hg. This increase was 8.8 mm Hg in hypotonics and 4.3 mm Hg in the normotonics. There was a certain degree of hypomotility of the esophageal body in 14 patients (23.3%) and, of this group, 4 (28.5%) improved postoperatively. Pathological acid reflux was found in 51 cases (85.0%) by pH monitoring. The mean of the preoperative DeMeester score was 31.4, later dropping to 3.2. Esophageal manometry and 24-hour pH monitoring are effective methods for revealing the level of functional modification established by anti-reflux surgery and for helping to objectively perform the selection.
腹腔镜和胸腔镜技术为食管功能障碍的矫正提供了新的维度。然而，治疗的成功取决于确认食管疾病是症状的病因，取决于理解功能障碍的根本原因以及确定手术患者。本研究是一项对采用林德手术治疗胃食管反流病（GERD）的患者的回顾性研究。本研究的目的是确定常规使用食管测压和24小时pH监测以选择患者并进行术前和术后功能评估的价值。41名患者（68.3%）存在低张性食管下括约肌。术前平均压力为9.2毫米汞柱，术后为15.2毫米汞柱，增加了6.0毫米汞柱。低张性患者增加了8.8毫米汞柱，正常张力患者增加了4.3毫米汞柱。14名患者（23.3%）存在一定程度的食管体部运动减弱，其中4名（28.5%）术后有所改善。通过pH监测发现51例（85.0%）存在病理性酸反流。术前DeMeester评分平均值为31.4，后来降至3.2。食管测压和24小时pH监测是揭示抗反流手术所建立的功能改变程度以及有助于客观进行患者选择的有效方法。
