Kawahara Hisayoshi, Tazuke Yuko, Soh Hideki, Yoneda Akihiro, Fukuzawa Masahiro
Department of Pediatric Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan.
J Pediatr Surg. 2014 Dec;49(12):1742-5. doi: 10.1016/j.jpedsurg.2014.09.008. Epub 2014 Oct 3.
BACKGROUND/PURPOSE: The purpose of this study was to retrospectively investigate whether laparoscopy-aided gastrostomy placement (LGP) improved or worsened gastroesophageal reflux (GER) in neurological impairment (NI) patients.
Subjects included 26 NI patients nourished via nasogastric tubes (age, 1-17years; median, 6years). They were divided into groups based on the percentage of time with an esophageal pH <4.0 (reflux index: RI) before LGP: Group 1 (GI, n=13), RI <5.0%; Group II (GH, n=13), RI ≥5.0%. Acid/nonacid reflux episodes (RE) were evaluated using combined pH-multichannel intraluminal impedance (pH-MII) monitoring, and gastric emptying was measured with the C breath test before and after LGP.
RI and number of RE evaluated with pH analyses and number of total/acid distal and proximal bolus RE with pH-MH increased significantly in GI. RI and acid clearance time with pH analyses and number of total bolus RE with pH-MII decreased significantly in GH. Gastric emptying parameters did not change significantly in GI, whereas the half-gastric emptying time and gastric emptying coefficient improved significantly in GH.
LGP reduces GER in NI patients with pathological GER by improving gastric emptying, although it has a paradoxical influence on those without pathological GER.
背景/目的：本研究的目的是回顾性调查腹腔镜辅助胃造口术（LGP）对神经功能障碍（NI）患者的胃食管反流（GER）是改善还是恶化。
研究对象包括26例通过鼻胃管喂养的NI患者（年龄1至17岁，中位数6岁）。根据LGP术前食管pH值<4.0的时间百分比（反流指数：RI）将他们分为两组：第1组（GI，n = 13），RI<5.0%；第II组（GH，n = 13），RI≥5.0%。使用联合pH值-多通道腔内阻抗（pH-MII）监测评估酸/非酸反流事件（RE），并在LGP前后用C呼气试验测量胃排空情况。
GI组中，通过pH分析评估的RI和RE数量以及通过pH-MH评估的总/酸远端和近端团块RE数量显著增加。GH组中，通过pH分析评估的RI和酸清除时间以及通过pH-MII评估的总团块RE数量显著减少。GI组的胃排空参数无显著变化，而GH组的半胃排空时间和胃排空系数显著改善。
LGP通过改善胃排空减少了患有病理性GER的NI患者的GER，尽管它对无病理性GER的患者有矛盾的影响。
