| 半夏厚朴汤联合“3-1针法”腹腔镜胃底折叠术治疗胃食管反流病的临床疗效分析 |
| Analysis of the clinical efficacy of Banxia Houpo Decoction combined with "3-1 Needle Method" laparoscopic fundoplication in the treatment of gastroesophageal reflux disease |
| DOI： |
| 中文关键词: 胃食管反流病 半夏厚朴汤 腹腔镜 胃底折叠术 |
| 英文关键词: Laparoscopy Fundoplication Gastroesophageal reflux disease |
| 基金项目:国家中医药管理局重大疑难疾病中西医临床协作项目 |
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| 中文摘要: |
| 【】目的:探讨半夏厚朴汤联合腹腔镜胃底折叠术(不完全打开食管裂孔四针法食管前180度胃底折叠术,以下简称“3-1针法”)治疗胃食管反流病(gastroesophageal reflux disease,GERD)的安全性和短期临床疗效。方法:将2022年6月至2024年6月河北省中医院收治的70例胃食管反流病患者纳入研究,采用随机数表法将患者分为观察组和对照组,每组35例。两组患者行“3-1针法”手术治疗,对照组采用常规的术后治疗,观察组在对照组治疗的基础上服用半夏厚朴汤,连续服用1个月。治疗后,总结“3-1针法”手术方法及技巧,比较两组患者的治疗前后反流症状指数量表(reflux symptom index,RSI)、胃食管反流病自测量表(Gerd Q)、反流性疾病问卷量表(RDQ)、食管下括约肌(Lower Esophageal Sphincter,LES)静息压力、24 h 食管 pH 连续监测DeMeester 评分五个指标。结果:70例患者均顺利实施“3-1针法”腹腔镜胃底折叠术,无死亡及中转开放手术病例。术后均未发生腹腔出血、腹腔感染和消化道穿孔等短期严重并发症。与术前相比,70例患者术后1年RSI评分降低 【(26.34±2.9)vs(1.63±0.9)分,t = 67.45,P = 0.000】,且观察组降低程度优于对照组(P＜0.05)；Gerd Q 评分降低【(12.80±1.8)vs(2.57±1.8)分,t = 33.72,P = 0.000】,且观察组降低程度优于对照组(P＜0.05)；RDQ评分降低【(13.8±1.5)vs(1.0±0.6)分,t = 56.78,P = 0.000】,观察组与对照组差异无统计学意义(P＜0.05)。术后1年内行高分辨率食管测压(hjgh resolution esophagealmanometry,HREM),与术前相比,术后LES静息压明显升高 【(6.43±1.0)vs(23.37±2.6)分,t = -50.31,P = 0.000】,观察组与对照组差异无统计学意义(P＞0.05)；术后1年内行24 h 食管 pH 连续监测,与术前相比,术后DeMeester 评分明显降低【(41.76 ± 6.1)vs(5.30 ± 1.4),t = 46.57,P = 0.000】,且观察组降低程度优于对照组(P＜0.05)。结论:70例患者术后恢复快、疼痛轻,抗反流效果好。术后未出现严重并发症,随访1年无复发和吞咽困难发生。“3-1针法”术式治疗GERD安全可行,半夏厚朴汤有助于提高术后的临床疗效。 |
| 英文摘要: |
| Objective:To explore the safety and short-term clinical efficacy of Banxia Houpo Decoction combined with laparoscopic fundoplication (incomplete opening of the esophageal hiatus four-needle method 180-degree anterior fundoplication of the esophagus, hereinafter referred to as "3-1 needle method") in the treatment of gastroesophageal reflux disease (GERD)? Methods: A total of 70 patients with gastroesophageal reflux disease admitted to Hebei Provincial Hospital of Traditional Chinese Medicine from June 2022 to June 2024 were included in the study. The patients were divided into the observation group and the control group by random number table method, with 35 cases in each group. Two groups of patients underwent "3-1 needle method" surgical treatment. The control group received conventional postoperative treatment, while the observation group took Banxia Houpo Decoction on the basis of the treatment in the control group for one month continuously. After the treatment, summarize the surgical methods and techniques of the "3-1 needle method", and compare the reflux symptom index scales (reflux symptom index) of the two groups of patients before and after treatment. Five indicators: RSI, Gastroesophageal Reflux Disease Self-Measurement Scale (Gerd Q), Reflux Disease Questionnaire Scale (RDQ), resting pressure of Lower Esophageal Sphincter (LES), and DeMeester score for 24-hour continuous monitoring of esophageal pH.Results: All 70 patients successfully underwent laparoscopic fundoplication using the "3-1 needle method", with no deaths or cases converted to open surgery. No short-term serious complications such as abdominal hemorrhage, abdominal infection or digestive tract perforation occurred after the operation. Compared with that before the operation, the RSI score of 70 patients decreased one year after the operation [(26.34±2.9) vs (1.63±0.9) points, t = 67.45, P = 0.000], and the degree of decrease in the observation group was better than that in the control group (P < 0.05). The Gerd Q score decreased [(12.80±1.8) vs (2.57±1.8) points, t = 33.72, P = 0.000], and the degree of decrease in the observation group was better than that in the control group (P < 0.05); The RDQ score decreased [(13.8±1.5) vs (1.0±0.6) points, t = 56.78, P = 0.000], and there was no statistically significant difference between the observation group and the control group (P < 0.05). High-resolution esophagealmanometry (hjgh) was performed within one year after the operation. Compared with that before the operation, the resting pressure of LES significantly increased after the operation [(6.43±1.0) vs (23.37±2.6) points, t = -50.31] P = 0.000. There was no statistically significant difference between the observation group and the control group (P > 0.05). Continuous 24-hour esophageal pH monitoring was performed within one year after the operation. Compared with that before the operation, the DeMeester score significantly decreased after the operation [(41.76 ± 6.1) vs (5.30 ± 1.4), t = 46.57, P = 0.000], and the degree of decrease in the observation group was better than that in the control group (P < 0.05).Conclusion: The 70 patients recovered quickly after the operation, experienced mild pain and had good anti-reflux effects. No serious complications occurred after the operation. During the one-year follow-up, there was no recurrence or dysphagia. The "3-1 needle method" surgical approach is safe and feasible for the treatment of GERD, and Banxia Houpo Decoction is helpful to improve the clinical efficacy after the operation |
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