McGouran R C, Galloway J M
Department of Gastroenterology, Queen Elizabeth Hospital, Norfolk, England.
Gastrointest Endosc. 1990 Sep-Oct;36(5):439-43. doi: 10.1016/s0016-5107(90)71111-x.
Low yield pressure of the lower esophageal sphincter is associated with esophageal reflux, and fundoplication must increase yield pressure if it is to prevent reflux. We attempted to increase yield pressure endoscopically in the dog by using the Nd:YAG laser to produce a fibrous scar at the cardia in the approximate line of the gastric sling fibers. Ten beagle dogs were studied. In a pilot study with two dogs, 15 watts for 4.2 sec were found to produce a scar deep into the muscle coat of the stomach. Three configurations of scar were used. One produced significant rises in yield pressure in all four of the dogs treated, the second produced a significant rise in one of the two dogs treated, and the third caused a significant drop in yield pressure in the one dog treated. One dog died of gastric perforation 10 days after lasering, but no other animal experienced any ill effects. These findings may have therapeutic implications for the management of esophageal reflux.
食管下括约肌低顺应性压力与食管反流相关，而胃底折叠术若要预防反流，就必须增加顺应性压力。我们试图通过使用钕钇铝石榴石激光在犬的心底部胃悬带纤维大致走行处产生纤维性瘢痕，以内镜方式增加顺应性压力。对10只比格犬进行了研究。在对2只犬的初步研究中，发现15瓦功率照射4.2秒可在胃肌层深处产生瘢痕。使用了三种瘢痕形态。第一种在接受治疗的所有4只犬中使顺应性压力显著升高，第二种在接受治疗的2只犬中的1只中使顺应性压力显著升高，而第三种在接受治疗的1只犬中导致顺应性压力显著下降。1只犬在激光治疗后10天死于胃穿孔，但没有其他动物出现任何不良反应。这些发现可能对食管反流的治疗具有启示意义。
