Department of Surgery, School of Medicine, Kitasato University, 2-1-1, Asamizodai, Minami-ku, Sagamihara, Kanagawa, 252-0380, Japan,
Surg Today. 2014 Apr;44(4):740-7. doi: 10.1007/s00595-013-0704-4. Epub 2013 Aug 23.
This study was designed to clarify whether laparoscopic antireflux surgery (LARS) improves the esophageal body motility (EBM) in patients with reflux esophagitis.
Thirty-five patients with gastroesophageal reflux disease (GERD) scheduled to undergo LARS were divided into a mild esophagitis group (ME; n = 18, Grade O:A:B = 7:10:1) and a severe esophagitis group (SE; n = 17, Grade C:D = 13:4), according to the Los Angeles classification of reflux esophagitis. The types of fundoplication (Nissen/Toupet) were 6/12 in the ME group and 4/13 in the SE group. Esophageal pH monitoring and manometry were performed before and 1 year after surgery.
The fraction time of a pH below 4 significantly decreased after surgery in both groups. The LES pressures did not change significantly after surgery in the ME group, but significantly increased in the SE group. The peristaltic amplitudes 18 and 13 cm above the LES did not change significantly after surgery in either group. The peristaltic amplitudes 8 and 3 cm above the LES did not change significantly after surgery in the ME group, but significantly increased after surgery in the SE group.
The preoperative EBM was not improved by LARS in patients with GERD and mild mucosal breaks in the esophagus, but the preoperative middle to distal EBM was improved by LARS in patients with GERD and severe mucosal breaks.
本研究旨在阐明腹腔镜抗反流手术（LARS）是否能改善反流性食管炎患者的食管体动力（EBM）。
35 名计划行 LARS 的胃食管反流病（GERD）患者根据洛杉矶反流性食管炎分类标准分为轻度食管炎组（ME；n=18，O:A:B 级=7:10:1）和重度食管炎组（SE；n=17，C:D 级=13:4）。ME 组的胃底折叠术类型为 6/12（Nissen/Toupet），SE 组为 4/13。在术前和术后 1 年进行食管 pH 监测和测压。
两组术后 pH 值<4 的时间分数均显著下降。ME 组术后 LES 压力无显著变化，而 SE 组显著增加。LES 上方 18cm 和 13cm 的蠕动幅度术后均无显著变化。ME 组 LES 上方 8cm 和 3cm 的蠕动幅度术后无显著变化，而 SE 组术后显著增加。
对于食管黏膜轻度损伤的 GERD 患者，LARS 术前 EBM 无改善，但对于食管黏膜中重度损伤的 GERD 患者，LARS 术前中远端 EBM 得到改善。
