Soyer T, Karnak I, Tanyel F C, Senocak M E, Ciftci A O, Büyükpamukçu N
Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Eur J Pediatr Surg. 2007 Jun;17(3):158-62. doi: 10.1055/s-2007-965393.
BACKGROUND/PURPOSE: Surgery is indicated for the treatment of gastroesophageal reflux disease (GERD) when medical treatment fails or complications are encountered in children. However, it has not been fully established how the results after surgery can be evaluated. A prospective study was performed to evaluate the results of surgical therapy for GERD by pH monitoring (PM) and esophageal manometry (EM) in children.
Patients who were candidates for anti-reflux surgery between 2003 and 2004 were evaluated for symptoms, growth and results of PM and EM both in the pre- and postoperative periods.
Thirteen patients were included (mean age = 6.65 +/- 3.28 years, male/female ratio = 10/3). Most frequently occurring symptoms were recurrent respiratory infections (RRI) (n = 11) and vomiting (n = 8). Nissen fundoplication was performed because of unresponsiveness to treatment (n = 10), RRI (n = 9), failure to thrive (n = 7) and esophagitis (n = 2) after medical treatment (2 - 36 months). Symptoms were resolved in 83.9 % of patients and were not changed in 16.1 % following surgery. Weight percentiles had significantly improved (pre: 12.38, post: 25.4, p < 0.05) during a short follow-up period (1 - 4 months). Mean reflux index (pre: 24.73 +/- 21.07 %, post: 0.93 %, min: 0 - max: 3.6, p < 0.05), reflux time (pre: 368 +/- 313 min, post: 17.1 +/- 15.9 min, p < 0.05), number of episodes (pre: 344.7 +/- 343.6, post: 19.53 +/- 11.13, p < 0.05) and number of reflux episodes longer than 5 minutes (pre: 4.3, min: 0 - max: 58, post: 0.61, min: 0 - max: 3, p < 0.05) were found to be reduced after surgery by PM. Lower esophageal sphincter pressure (pre: 55 +/- 27 cmH (2)O, post: 64.46 +/- 30.85 cmH (2)O), contraction amplitude (pre: 141.92 +/- 69.11 cmH (2)O, post: 130.69 +/- 45 cmH (2)O) and contraction velocity (pre: 1.94 cm/s, min: 0.1 - max: 7.5, post: 4.29 cm/s, min: 0.2 - max: 10) did not differ postoperatively (p > 0.05). However, contraction times were decreased postoperatively (pre: 73.6 +/- 52.9 s, post: 27.67 +/- 20.1 s, p < 0.05) and were found to be correlated with reflux time and the number of reflux episodes longer than 5 minutes.
Nissen fundoplication is effective for the treatment of GERD. It supports the anti-reflux mechanism without affecting esophageal motility except for contraction times. The decrease in contraction time after surgery can be explained by the decreases in reflux time and in the number of reflux episodes longer than 5 minutes. PM and EM confirmed the clinical improvement and can be used for the evaluation of results of NF.
背景/目的：当药物治疗失败或儿童出现并发症时，手术可用于治疗胃食管反流病（GERD）。然而，目前尚未完全明确如何评估手术后的效果。本研究旨在通过pH监测（PM）和食管测压（EM）评估儿童GERD手术治疗的效果。
对2003年至2004年间适合抗反流手术的患者在术前和术后进行症状、生长情况以及PM和EM结果的评估。
纳入13例患者（平均年龄=6.65±3.28岁，男/女比例=10/3）。最常见的症状是反复呼吸道感染（RRI）（n=11）和呕吐（n=8）。因治疗无效（n=10）、RRI（n=9）、生长发育不良（n=7）和药物治疗（2 - 36个月）后食管炎（n=2）而进行了nissen胃底折叠术。术后83.9%的患者症状得到缓解，16.1%的患者症状未改变。在短时间随访期（1 - 4个月）内，体重百分位数显著改善（术前：12.38，术后：25.4，p<0.05）。通过PM发现，术后反流指数（术前：24.73±21.07%，术后：0.93%，最小值：0 - 最大值：3.6，p<0.05）、反流时间（术前：368±313分钟，术后：17.1±15.9分钟，p<0.05）、发作次数（术前：344.7±343.6，术后：19.53±11.13，p<0.05）以及反流发作超过5分钟的次数（术前：4.3，最小值：0 - 最大值：58，术后：0.61，最小值：0 - 最大值：3，p<0.05）均减少。食管下括约肌压力（术前：55±27cmH₂O，术后：64.46±30.85cmH₂O）、收缩幅度（术前：141.92±69.11cmH₂O，术后：130.69±45cmH₂O）和收缩速度（术前：1.94cm/s，最小值：0.1 - 最大值：7.5，术后：4.29cm/s，最小值：0.2 - 最大值：10）术后无差异（p>0.05）。然而，术后收缩时间缩短（术前：73.6±52.9秒，术后：27.67±20.1秒，p<0.05），且发现其与反流时间和反流发作超过5分钟的次数相关。
nissen胃底折叠术对GERD治疗有效。它支持抗反流机制，除收缩时间外不影响食管动力。术后收缩时间的缩短可由反流时间和反流发作超过5分钟次数的减少来解释。PM和EM证实了临床改善情况，可用于评估nissen胃底折叠术的效果。
