Mahmood Zahid, Byrne Patrick J, McMahon Barry P, Murphy Edward M, Arfin Qamrul, Ravi Narayanasamy, Weir Donald G, Reynolds John V
Department of Surgery & Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.
Am J Gastroenterol. 2006 Mar;101(3):431-6. doi: 10.1111/j.1572-0241.2006.00534.x.
Transesophageal endoscopic plication (TEP) is a novel endotherapeutic approach in the management of gastroesophageal reflux disease (GERD). This non-randomized prospective study compares TEP with laparoscopic Nissen fundoplication (LNF).
Twenty-four consecutive patients treated with LNF, and 27 managed by TEP were studied. Symptom severity scores, endoscopy, 24 h esophageal pH and esophageal manometry and quality-of-life assessments were obtained pre- and posttreatment.
In the LNF group the mean age was 36 yr (17-68) compared with 39 yr (22-62) in the TEP group. Symptom scoring, acid regurgitation score, reduction in the requirements of proton pump inhibitors (PPIs), and quality of life remained significantly improved in both groups at a median of 1 yr [10-18 months] follow-up post procedure. However, the improvement was significantly better in symptom score (p= 0.0383) and the control of acid reflux in the LNF group (p= 0.0007). Post-procedure dysphagia was more common in the LNF group.
Both techniques improved symptom score, acid regurgitation, quality of life, and reduced the requirements for PPIs. The control of heartburn and acid reflux was better for LNF. TEP, like LNF, is a safe and effective method of management of symptomatic GERD but further developments are necessary to ensure control of esophageal acid reflux.
经食管内镜折叠术（TEP）是治疗胃食管反流病（GERD）的一种新型内镜治疗方法。本非随机前瞻性研究比较了TEP与腹腔镜Nissen胃底折叠术（LNF）。
对连续接受LNF治疗的24例患者和接受TEP治疗的27例患者进行了研究。在治疗前后获取症状严重程度评分、内镜检查、24小时食管pH值、食管测压以及生活质量评估结果。
LNF组的平均年龄为36岁（17 - 68岁），而TEP组为39岁（22 - 62岁）。在术后中位随访1年[10 - 18个月]时，两组的症状评分、反酸评分、质子泵抑制剂（PPI）需求减少情况以及生活质量仍有显著改善。然而，LNF组的症状评分改善更显著（p = 0.0383），胃酸反流控制情况也更好（p = 0.0007）。术后吞咽困难在LNF组更为常见。
两种技术均改善了症状评分、反酸、生活质量，并减少了PPI的需求。LNF对烧心和胃酸反流的控制更好。TEP与LNF一样，是治疗有症状GERD的一种安全有效的方法，但需要进一步改进以确保食管胃酸反流得到控制。
