2016 硬皮病所致严重胃食管反流病的个体化治疗_病例及文献分析_胡志伟_吴继敏_汪忠镐_

· 论著 ·

硬皮病所致严重胃食管反流病的个体化治疗：

病例及文献分析

胡志伟1,吴继敏1,汪忠镐1,张玉1,纪涛1,燕超2，杜兴2

1.中国人民解放军火箭军总医院胃食管反流病科（北京 100088）；

2.首都医科大学宣武医院血管外科（北京 100053）

【摘要】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。

【关键词】硬皮病；食管动力；胃食管反流病；食管炎；腹腔镜胃底折叠术

Individualized Management of Severe Gastroesophageal Reflux Disease Secondary to Scleroderma: Case Study and Literature Review

HU Zhi-wei1, WU Ji-min1, WANG Zhong-gao1, ZHANG Yu1, JI Tao1, YAN Chao2, DU Xing2.

1.Department of Gastroesophageal Refl ux Disease, Rocket Force General Hospital, PLA, Beijing 100088, China;

2.V ascural Surgery Department, Xuanwu Hospital, Capital Medical University, Beijing 100053, China

Corresponding Author: WANG Zhong-gao, E-mail: zhonggaowang@

【Abstract】Objective To investigate the individualized management of severe gastroesophageal reflux disease (GERD) secondary to scleroderma, particularly the safety and feasibility of laparoscopic Toupet fundoplication for this entity. Methods From June, 2011 to June, 2014 six inpatient cases had severe GERD secondary to scleroderma were docu-mented. Endoscopy, esophageal high-resolution manometry and 24 hours reflux monitoring were applied for GERD evalua-tion. Maintenance of conservative treatment was carried out for the 2 cases who responsed well to medication therapy, laparoscopic Toupet fundoplication was done for the 4 cases who had extraesophageal symptom and not well controlled by medication. The patients were followed-up for an average of 2.2 years (1 to 4 years) after discharge, and endoscopic was rechecked during the followed-up. Results The esophageal symptom of regurgitation, heartburn and dysphagia, as well as the extraesophageal symptom of cough and asthma significantly relieved during followed-up, meanwhile the anti-reflux medication was reduced or stopped in all the patients. For the 4 surgical patient, one had partial recurrence and no comp-lication occurred. Conclusions The management of severe GERD secondary to scleroderma could follow the strategy of controlling the primary disease, living adjustment, anti-reflux medication and surgery step by step. The laparoscopic Toupet fundoplication may be safe, effective and feasible for the medication unmet patients, it deserves further studies.

【Key words】Scleroderma; Esophageal motility; Gastroesophageal reflux disease; Esophagitis; Laparoscopic fundoplication

【Foundation item】Supported by Beijing Municipal Science and Technology Commission, （No. Z141107002514109）DOI：10.7507/1007-9424.20160312

基金项目：首都临床特色应用研究（项目编号：Z141107002514109）

作者简介：胡志伟（1983年-），男，福建省莆田市人，博士，主治医师，主要从事胃食管反流病胃肠外科工作，E-mail：higherife@ 通信作者：汪忠镐；E-mail：zhonggaowang@