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首页> 外文期刊>Surgical Endoscopy >Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: an anti-reflux procedure is required.
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Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: an anti-reflux procedure is required.

机译：腹腔镜幽门肌切开术后胃食管反流的客观分析：需要进行反流手术。

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BACKGROUND: Controversy exists over the necessity of performing a concurrent antireflux procedure with a Heller myotomy. We therefore sought to objectively analyze gastroesophageal reflux following laparoscopic Heller myotomy where an antireflux procedure was not performed. METHODS: A prospective database of 66 cases of laparoscopic Heller myotomy performed between November 1996 and June 2002 was reviewed. Previous, concurrent, or subsequent fundoplication was performed in 12 patients; therefore 54 patients without antireflux procedures were available for analysis. Follow-up included symptomatic assessment in 50 patients (93%). Heartburn was assessed on a four-point scale with clinical significance defined as >2 episodes/week. Objective testing, including endoscopy, esophagogram, manometry, and 24-h pH monitoring, was offered to all patients. Objective evidence of reflux was defined as the composite endpoint of positive 24-h pH monitoring or esophagitis on endoscopy. RESULTS: Significant heartburn was reported in 15 of 50 patients (30%). Positive 24-h pH recordings were seen in 11 of 22 patients tested while esophagitis was seen in 13 of 21 patients tested, resulting in objective evidence of reflux in 18 of 30 patients tested (60%). Of these 18 patients, seven did not have significant heartburn. All 12 patients without objective reflux did not have significant heartburn. Therefore, of the 30 patients with objective testing, seven (23%) had objective reflux without subjective heartburn (silent reflux). CONCLUSION: Objective analysis reveals an unacceptable rate of gastroesophageal reflux in laparoscopic Heller myotomy without an antireflux procedure. We therefore recommend performing a concurrent antireflux procedure.
机译：背景：关于同时进行海勒肌切开术的抗反流手术的必要性存在争议。因此，我们试图客观地分析未进行抗反流手术的腹腔镜海勒肌切开术后的胃食管反流。方法：回顾性分析1996年11月至2002年6月进行的66例腹腔镜Heller肌切开术的前瞻性数据库。先前，同时或随后的胃底折叠术在12例患者中进行;因此，有54例无抗反流手术的患者可用于分析。随访包括50例患者的症状评估（93％）。以四点量表评估烧心，其临床意义定义为每周> 2次发作。为所有患者提供客观的检查，包括内窥镜检查，食管造影，测压和24小时pH监测。返流的客观证据定义为内窥镜检查中24小时pH值监测阳性或食管炎的综合终点。结果：50名患者中有15名（30％）报告了严重的胃灼热。测试的22名患者中有11名24小时的pH记录为阳性，而测试的21名患者中有13名出现了食管炎，从而客观地证明了接受测试的30名患者中有18名（60％）出现反流。在这18位患者中，有7位没有明显的胃灼热。所有12例无客观反流的患者均没有明显的胃灼热。因此，在30例接受客观检查的患者中，有7例（23％）发生了客观反流而没有主观胃灼热（沉默反流）。结论：客观分析显示，在没有抗反流手术的情况下，腹腔镜Heller肌切开术中胃食管反流的发生率是不可接受的。因此，我们建议执行并发的防反流程序。

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