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目的 探讨治疗胃食管反流病（GERD）的新方法——胃镜下腔内折叠术（ELGP）的操作方法、适应证及禁忌症等问题。方法 选择无服药情况下出现每周3次以上烧心或反酸、食物反流,并且24 h食管pH监测证实胃酸异常者,共26例进行ELGP,其中2例为贲门切除术后的胃食管反流病患者。26例 GERD患者食管下端裂口直径1.5～3.5cm,平均 2.5cm;并食管裂孔疝20例,达77％。缝合器为美国BARD公司二代缝合器。术前检查、常规胃镜观察后,辅助静脉麻醉,在齿状线下或吻合口下1～3cm缝合,采用环行、纵行或两种方法结合治疗。记录手术前后食管裂口大小、缝合位置、针间距、缝合皱褶数、术中不良反应等。结果 共缝合32例次,其中环行缝合17例次,纵行缝合11例次,环行和纵行结合缝合4例次。两针间距1～3cm,两褶间距约1.5～2cm。每例次1～4个褶,平均每例2.3个褶。缝合后食管裂口平均约1.5 cm。烧心及反流症状改善总有效率76％（完全缓解36％,部分缓解40％）,无效24％。1例感冒患者术中出现呼吸困难,余无严重并发症。结论胃镜下腔内折叠术能明显改善胃食管反流病的症状,2cm以上的食管裂孔疵及贲门切除术后胃食管反流均可应用该方法进行治疗,术程安全。
Objective To explore the new method of treating gastroesophageal reflux disease (GERD), such as operation method, indications and contraindications of gastroscopic endoscopic folding (ELGP). Methods Choose no more than three times a week when there was heartburn or acid reflux, food reflux, and 24 h esophageal pH monitoring confirmed gastric acid abnormalities, a total of 26 patients were ELGP, of which 2 cases after cardiactomy gastroesophageal reflux Ill patients. Twenty-six GERD patients had a diameter of 1.5-3.5 cm at the lower end of the esophagus with an average of 2.5 cm. In addition, 20 patients had esophageal hiatal hernia, which was 77%. Stapler for the United States BARD second-generation stapler. Preoperative examination, conventional gastroscope observation, assisted intravenous anesthesia, in the dentate line or anastomosis 1 ~ 3cm suture, using ring, longitudinal or two methods combined treatment. The size of esophageal suture, suture position, needle spacing, number of suture folds and intraoperative adverse reactions were recorded before and after surgery. Results A total of 32 cases were sutured, of which 17 cases were sutured circumferentially, 11 cases were longitudinally sutured, and 4 cases were combined sutured and longitudinally. Two needles spacing 1 ~ 3cm, bilaterally spaced about 1.5 ~ 2cm. Each case 1 to 4 folds, an average of 2.3 pleats per case. Suture esophageal rips average about 1.5 cm. The total effective rate of heartburn and reflux symptoms was 76% (complete remission 36%, partial remission 40%), ineffective 24%. One patient had dyspnea during operation, and no serious complications occurred. Conclusions Gastroscopic endoscopic surgery can significantly improve the symptoms of gastroesophageal reflux disease. Esophageal foramen lesions above 2cm and gastroesophageal reflux after cardiactomy can be treated by this method and the procedure is safe.