von Diemen V, Trindade E N, Trindade M R M
Digestive Surgery Service, Hospital de Clínicas of Porto Alegre, Ramiro Barcelos, 2350. 7º Floor/Room 743, Porto Alegre, RS, CEP 90035-903, Brazil.
Department of Surgery, Federal University of Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, Rio Grande do Sul, Brazil.
Surg Endosc. 2016 Nov;30(11):5091-5098. doi: 10.1007/s00464-016-4858-1. Epub 2016 Mar 22.
Gastroesophageal reflux disease (GERD) is defined by the intensity and/or quality of the reflux of gastric or duodenal contents into the esophagus. Surgical treatment of GERD has shown conflicting results and unacceptable recurrence rates, mainly due to herniation of the antireflux valve into the chest. A variety of techniques has been proposed to reduce GERD recurrence, including routine use of prosthesis in cruroplasty. The prevalence of GERD in patients with hiatal hernia (HH) can reach 94 %. It is possible that the phrenoesophageal ligament (POL) engaged in the stabilization of the gastroesophageal junction in the abdomen may be an etiological factor of HH. We conducted a study to evaluate collagen in the constitution of the POL in patients with HH and cadavers without HH.
POL samples were collected from 29 patients with HH and GERD (cases) and 32 samples from cadavers without HH (controls). Total collagen was quantified through the Picrosirius red histochemical technique, and type-I and type-III collagens were quantified immunohistochemically using a monoclonal antibody. The stained slides were photographed, and images were quantified by computer software (Image Pro Plus) to count the pixels per field.
The mean age was 49.5 (±11.5) years for the cases and 38.5 (±13) years for the controls (p < 0.01). Seventeen cases (58.6 %) and six controls (18.75 %) were female (p < 0.01). The quantity of total (p < 0.01), type-I (p < 0.01), and type-III (p < 0.05) collagens was significantly lower by about 60 % in patients with HH compared with controls.
Our data indicate that the composition of POL for patients with GERD and HH includes less total, type-I, and type-III collagens than that of the POL of cadavers without HH. The quality of the POL may be an etiological factor in the development of HH.
胃食管反流病（GERD）是由胃或十二指肠内容物反流至食管的强度和/或性质所定义的。GERD的手术治疗结果存在矛盾，复发率也难以接受，主要原因是抗反流瓣膜疝入胸腔。为降低GERD复发率，人们提出了多种技术，包括在贲门成形术中常规使用假体。食管裂孔疝（HH）患者中GERD的患病率可达94%。参与稳定腹部胃食管交界处的膈食管韧带（POL）可能是HH的一个病因。我们开展了一项研究，以评估HH患者和无HH尸体的POL组成中的胶原蛋白情况。
从29例患有HH和GERD的患者（病例组）中采集POL样本，并从32例无HH的尸体（对照组）中采集样本。通过天狼星红组织化学技术对总胶原蛋白进行定量，并使用单克隆抗体通过免疫组织化学方法对I型和III型胶原蛋白进行定量。对染色后的玻片进行拍照，并通过计算机软件（Image Pro Plus）对图像进行定量，以计算每个视野的像素数。
病例组的平均年龄为49.5（±11.5）岁，对照组为38.5（±13）岁（p < 0.01）。17例病例（58.6%）和6例对照组（18.75%）为女性（p < 0.01）。与对照组相比，HH患者的总胶原蛋白（p < 0.01）、I型胶原蛋白（p < 0.01）和III型胶原蛋白（p < 0.05）的量显著降低约60%。
我们的数据表明，与无HH尸体的POL相比，GERD和HH患者的POL组成中总胶原蛋白、I型胶原蛋白和III型胶原蛋白含量更少。POL的质量可能是HH发生的一个病因。
