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中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2020, Vol. 07 ›› Issue (01) : 29 -35. doi: 10.3877/ cma.j.issn.2095-8765.2020.01.002

所属专题： 经典病例； 文献；

论著

50例食管微量射频治疗难治性非糜烂性胃食管反流病的临床疗效研究
徐菲1, 吴继敏2, 何素玉1,†(), 梁宁林1, 曹丽鹏3, 王卉1, 何莲芬1, 王寒梅1, 贾映东4   
  1. 1. 629000　四川省遂宁市中心医院消化中心四病区
    2. 100088　北京，火箭军总医院胃食管反流病科
    3. 629000　四川省遂宁市中心医院消化中心五病区
    4. 629000　四川省遂宁市中心医院消化中心一病区
  • 收稿日期:2019-08-24 出版日期:2020-02-15
  • 通信作者: 何素玉
  • 基金资助:
    四川省卫生健康科研课题普及项目(19PJ282)

Investigation of Stretta radiofrequency in fifty patients with refractory nonerosive reflux disease

Fei Xu1, Jimin Wu2, Suyu He1,†(), Ninglin Liang1, Lipeng Cao3, Hui Wang1, Lianfen He1, Hanmei Wang1, Yingdong Jia4   

  1. 1. Department of The Fourth Digestive Disease Center, Suining Central Hospital of Sichuan Province, Suining 629000, China
    2. Department of gastroesophageal reflux disease, The General Hospital of the PLA Rocket Force, Beijing, China, 100088
    3. Department of The Fifth Digestive Disease Center, Suining Central Hospital of Sichuan Province, Suining 629000, China
    4. Department of The First Digestive Disease Center, Suining Central Hospital of Sichuan Province, Suining 629000, China
  • Received:2019-08-24 Published:2020-02-15
  • Corresponding author: Suyu He
  • About author:
    Corresponding author: He Suyu, Email:
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引用本文：

徐菲, 吴继敏, 何素玉, 梁宁林, 曹丽鹏, 王卉, 何莲芬, 王寒梅, 贾映东. 50例食管微量射频治疗难治性非糜烂性胃食管反流病的临床疗效研究[J]. 中华胃食管反流病电子杂志, 2020, 07(01): 29-35.

Fei Xu, Jimin Wu, Suyu He, Ninglin Liang, Lipeng Cao, Hui Wang, Lianfen He, Hanmei Wang, Yingdong Jia. Investigation of Stretta radiofrequency in fifty patients with refractory nonerosive reflux disease[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2020, 07(01): 29-35.

目的

探讨食管微量射频（Stretta）治疗难治性非糜烂性胃食管反流病（NERD）的短期临床疗效。

方法

收集2018年8月至2019年4月于四川省遂宁市中心医院接受Stretta治疗的难治性NERD患者50例的病例资料。其中，男性31例，女性19例，年龄32~66岁，平均年龄47.5岁。对比分析治疗前、后6个月患者的反流症状评分（RDQ）、生活质量评分（SF-36）、对治疗的满意度、食管下括约肌（LES）压力、24 h pH监测结果及质子泵抑制剂（PPI）使用情况。计量资料采用均数±标准差表示。符合正态分布的采用t检验，非正态分布采用秩和检验，计数资料比较采用卡方检验。

结果

50例Stretta治疗均顺利完成，无严重并发症及死亡病例。48例完成6个月后随访，反流症状及生活质量均明显改善。RDQ评分自17.0±5.3降至6.4±3.9（t=12.322,P=0.000），SF-36评分自546.6±149.8提升至607.4±143.5（t=-3.479,P=0.002)。45例（90%）患者对Stretta治疗疗效总体满意，LES压力自（9.9±4.3）mmHg（1 mmHg=0.133 kPa）升至（14.4±4.6）mmHg（t=-5.541,P=0.002)。治疗前、后6个月患者的24 h pH监测酸反流次数、食管酸暴露时间及DeMeester积分分别自62次、8.3%及28.7分降至30次(Z=-5.565,P=0.000)、4.4%(Z=-5.585,P=0.000)及13.0分（Z=-5.733,P=0.000）。62%轻度病理性酸反流及22%中度病理性酸反流患者反流积分可恢复至正常。50例患者中，42例（88%）完全停用PPI，5例（10%）减量服用PPI，1例（2%）继续原剂量服用PPI。2例症状持续患者于术后第4个月及5个月分别行腹腔镜下胃底折叠术，术后症状控制理想。

结论

Stretta治疗是一种安全有效的微创方法。术后能有效控制难治性NERD患者的症状，提高LES压力并减少病理性酸反流，尤其轻度病理性酸反流，减少甚至停用PPI。对Stretta治疗欠佳的NERD患者，经腹腔镜胃底折叠术可行并能有效改善临床疗效。

关键词: 食管微量射频治疗, 难治性胃食管反流病, 非糜烂性胃食管反流病

Obstract　To investigate the short-term clinical outcome of Stretta radiofrequency for patients with refractory nonerosive reflux disease (NERD).

Methods

Fifty patients with refractory NERD underwent Stretta procedure were enrolled. They were followed-up for six months after Stretta procedure. The symptom control, quality of life, satisfaction rate, lower esophageal sphincter (LES) pressure, 24-hour pH and proton pump inhibitor (PPI) usage were evaluated. The complications were assessed. The outcomes of the 6-months follow-up results were analyzed and compared with the baseline data.

Results

Stretta procedure was succeed in all 50 patients. No severe adverse events or complications occurred. Forty-eight patients finished the 6-month follow-up, Stretta was effective in both reducing total symptom scores (from 17.0±5.3 to 6.4±3.9, t=12.332, P=0.000) and improving quality of life scores (from 546.6±149.8 to 607.4±143.5, t=-3.479, P=0.002). Forty-five patients (94%) were satisfied with the intervention. LES pressure increased significantly (from 9.9±4.3 mmHg to 14.4±4.6 mmHg, t=-5.541, P=0.000). Regarding 24-hour pH monitoring, reflux episodes (62 vs. 30, Z=-5.565, P=0.000), pathological acid exposure (8.3% vs. 4.4%, Z=-5.583, P=0.000) and DeMeester score (28.7 vs.13.0, Z=-5.733, P=0.000) were improved significantly compared to the baseline (P=0.000). 62% patients with mild pathological acid reflux and 22% with moderate pathological acid reflux achieved normal esophageal acid exposure. At the 6-month follow-up, complete PPI cessation was achieved in 42 patients (88%), 5 patients (10%) took PPI on-demand while 1 patient (2%) took PPI as much as before the Stretta procedure. Two patients who cannot stop PPI underwent Laparoscopic Nissen fundoplication and achieved symptom control and PPI cessation, too.

Conclusions

The Stretta procedure was safe and effective in the short term for the management of NERD. It can improve LES pressure as well as 24-hour pH metrics, especially for mild reflux patients, and achieved improvement of symptom control and PPI cessation in the short term follow up. Fundoplication is feasible and effective after failed Stretta procedure.

Key words: Radiofrequency, Refractory gastroesophageal reflux disease, Nonerosive reflux disease
表1 Stretta治疗前后RDQ量表及SF-36量表积分
分值 RDQ量表 SF-36量表
治疗前 17.0±5.3 546.6±149.8
治疗6月后 6.4±3.9 607.4±143.5
t值 12.322 -3.479
P值 ＜0.05 ＜0.05
表2 Stretta治疗前后PPI运用情况及患者对治疗的总体满意度[例数（例数/总数%）]
PPI 使用情况 例数（例数/总数%）
完全停用PPI 42（88%）
减量服用PPI 5（10%）
继续原剂量PPI 1（2%）
满意度 45(94%)
表3 Stretta治疗前后LES压力检测结果
参数 LES 压力（n=48） 轻度反流（n=39） 中度反（n=9）
治疗前 9.9±4.3 9.9±4.7 8.6±2.9
治疗后 14.4±4.6 14.6±4.8 13.7±2.7
t值 -5.541 -10.013 -4.156
P值 ＜0.05 ＜0.05 ＜0.05
表4 Stretta治疗前后24 h pH监测结果
参数 酸反流次数 酸暴露时间 (%) DeMeester积分(n=48) 轻度反流(n=39) 中度反流(n=9)
治疗前 62(30~99) 8.3(4.5~20.0) 28.7(14.9~86.5) 22.3(14.9~45.8) 52.3(50.0~86.5)
治疗后 30(0~78) 4.4(0~12.8) 13.0(0.2~40.6) 12.5(0.2~45.0) 36.3(3.2~55.4)
Z值 -5.565 -5.583 -5.733 -4.69 -2.666
P值 ＜0.05 ＜0.05 ＜0.05 ＜0.05 ＜0.05
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