Lorusso D, Pezzolla F, Guerra V, Giorgio I
Divisione di Chirurgia, Istituto Scientifico Gastroenterologico S. De Bellis.
Minerva Chir. 1995 May;50(5):493-6.
Although duodenal ulcer and reflux esophagitis may frequently co-exist, it is not clear whether surgery for duodenal ulcer associated with reflux esophagitis should not be associated with anti-reflux plastic surgery. The authors make a retrospective evaluation of the prevalence of reflux esophagitis (endoscopic diagnosis) in a consecutive series of 633 patients undergoing elective gastric resection according to Billroth II for duodenal or pyloric ulcer during the period 1974-1992 and assess the effects of surgery on co-existent esophagitis. The prevalence of reflux esophagitis associated with duodenal or pyloric ulcer was 12.3%. In patients in whom stenosis represented the indication for ulcer surgery, the prevalence of esophagitis was 20%, whereas it was 5% in those operated because of failure to respond to medical therapy of hemorrhage (p = 0.000001). In 95% of patients, controlled endoscopically 6 months after surgery, Billroth II gastric resection led to the resolution or improvement of associated esophagitis. The authors conclude that by eliminating the main pathological factors of reflux esophagitis associated with duodenal ulcer (hypersecretion of gastric acid, impeded gastric emptying) gastric resection is sufficient to achieve the resolution of esophagitis.
尽管十二指肠溃疡和反流性食管炎可能经常并存，但对于与反流性食管炎相关的十二指肠溃疡手术是否应与抗反流整形手术联合进行尚不清楚。作者对1974年至1992年期间连续633例因十二指肠或幽门溃疡根据毕罗Ⅱ式进行择期胃切除术的患者中反流性食管炎（内镜诊断）的患病率进行了回顾性评估，并评估了手术对并存食管炎的影响。与十二指肠或幽门溃疡相关的反流性食管炎患病率为12.3%。在因狭窄而进行溃疡手术的患者中，食管炎患病率为20%，而因药物治疗出血无效而接受手术的患者中食管炎患病率为5%（p = 0.000001）。在术后6个月经内镜检查得到控制的患者中，95%的毕罗Ⅱ式胃切除术使相关食管炎得到缓解或改善。作者得出结论，通过消除与十二指肠溃疡相关的反流性食管炎的主要病理因素（胃酸分泌过多、胃排空受阻），胃切除术足以实现食管炎的缓解。
