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目的探讨继发于硬皮病的严重胃食管反流病(gastroesophageal reflux disease,GERD)的个体化治疗,特别是腹腔镜Toupet胃底折叠术用于治疗本病的安全性和可行性。方法收集2011年6月至2014年6月期间继发于硬皮病的严重GERD住院患者6例。入院后行胃镜、食管高分辨率测压、24 h反流检测等胃食管反流评估。2例药物疗效良好者维持保守治疗,4例合并食管外症状且药物控制不佳者行腹腔镜胃底折叠术治疗,术后平均随访2.2年(1~4年),并复查胃镜。结果随访期间,6例患者的反酸、烧心、吞咽困难等食管内症状和咳嗽、喘息等食管外症状均得到有效改善,抗反流药物减量或停药。4例手术患者中1例部分复发,无吞咽困难等术后并发症。结论继发于硬皮病的严重GERD的治疗可采取控制原发病、生活调理、抗反流药物治疗、手术治疗等方式循序渐进地进行。腹腔镜下Toupet胃底折叠术对于药物控制不佳者可能是安全并且是有效的,具有一定的可行性,值得进一步的探讨和研究。
Objective To investigate the individualized treatment of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, especially the safety and feasibility of laparoscopic Toupet fundoplication for the treatment of this disease. Methods Six patients with severe GERD inpatients with secondary to scleroderma between June 2011 and June 2014 were collected. After admission, gastroscopy, esophageal high-resolution manometry, 24 h reflux detection and other gastroesophageal reflux were evaluated. 2 cases of conservative treatment with good drug efficacy, 4 cases of combined with extra-esophageal symptoms and poor drug control were treated with laparoscopic fundoproliferation. The average follow-up was 2.2 years (1-4 years) and gastroscopy was performed. Results During follow-up, esophageal symptoms such as acid reflux, heartburn, dysphagia and other extra-esophageal symptoms such as cough and wheezing were effectively improved and anti-reflux drugs were reduced or discontinued. One of the four patients underwent surgical resection, with no postoperative complications such as dysphagia. Conclusions The treatment of severe GERD secondary to scleroderma can be carried out step by step by means of controlling the primary disease, life conditioning, anti-reflux drug therapy and surgical treatment. Laparoscopic Toupet fundoplication may be safe and effective for those with poor drug control, which is feasible and worthy of further exploration and research.