腹腔外科手术后逆流症状解决的预后:手术前食道检测如何帮助?
Rachel Sillcox1, Mary K Bryant2,3, Saurabh Khandelwal2
1Department of Surgery, University of Washington, 1959 NE Pacific St, Box 3564101, Seattle, WA, 98195, USA. rachel.sillcox@gmail.com.
Obesity surgery
|June 12, 2024
概括
在垂直袖子胃切除术 (VSG) 后,未解决的反流比Roux-en-Y胃旁路术 (RYGB) 更常见. 无效的食道运动性预测RYGB后的反流,而像失食症这样的症状预测VSG后的反流.
科学领域:
- 腹部外科 腹部外科
- 胃肠病学 胃肠病学
- 外科手术的结果
背景情况:
- 胃食道逆流性疾病 (GERD) 可以在减肥手术后持续或发展.
- 预测哪些患者在手术后会出现未解决的反流症是具有挑战性的.
- 手术前的食道功能测试可能为预测手术后的逆流提供了洞察力.
研究的目的:
- 为了确定腹手术后一年未解决的逆流的术前预测因素.
- 为了比较垂直袖子胃切除术 (VSG) 和Roux-en-Y胃绕道术 (RYGB) 之间未解决的反流的发生率.
- 调查食道测量和pH测试在预测术后逆流中的作用.
主要方法:
- 对接受VSG或RYGB治疗的成年患者进行了回顾性审查,并出现了手术前的反流症状 (2015-2021年).
- 所有患者都接受了手术前的pH监测和高分辨率测量.
- 统计分析包括费舍尔的精确测试,克鲁斯卡尔·瓦利斯测试和单变物流回归来确定未解决的逆流的预测因素.
主要成果:
- 在VSG (46.5%) 和RYGB (19.4%) 相比,未解决的反流发生的频率更高.
- 在RYGB患者中,无效食道机动性 (IEM) 在未解决的逆流患者中显著高 (31.6%与8.9%,p=0.01).
- 患有未解决逆流症的VSG患者报告了更多的手术前消化不良 (13.3%对2.9%,p=0.04) 和更高的质子抑制剂 (PPI) 使用率 (56.7%对39.1%,p=0.05).
结论:
- 与Roux-en-Y胃绕道相比,垂直袖子胃切除术与未解决的术后逆流的发生率更高.
- 术前无效的食道运动是RYGB后未解决的逆流的重要预测因素.
- 在VSG患者中,手术前的消化不良和PPI使用表明,主观症状报告可能预测反流,尽管与客观测试缺乏相关性.
相关概念视频
Gastroesophageal Reflux Disease II: Clinical Features and Management
68
Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
68
Barrett Esophagus-II: Clinical Manifestations and Management
138
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
138
Esophageal Strictures-II: Clinical Features and Management
63
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
63
Barrett Esophagus-I: Introduction
86
Barrett's esophagus is a medical condition where the esophageal mucosa is significantly damaged by stomach acid or other digestive fluids, often due to long-term exposure associated with gastroesophageal reflux disease (GERD). In GERD, a weakened or abnormally relaxed lower esophageal sphincter allows stomach acid to flow persistently into the esophagus.
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
86
Upper GI Series: Barium Swallow
247
The Barium Swallow Study, or a Barium Esophagogram, is a diagnostic imaging method used to visualize the upper gastrointestinal (GI) tract, including the esophagus, stomach, and small intestine. It employs barium sulfate, a radiopaque contrast material, to provide clear images of the upper digestive system, helping to identify abnormalities, diseases, or structural issues.
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...
247
Endoscopic Procedures I: Esophagogastroduodenoscopy
101
An Esophagogastroduodenoscopy (EGD) is a diagnostic procedure in which an endoscopist uses a flexible, lighted endoscope to visualize the upper gastrointestinal (GI) tract. The procedure includes visualizing the oropharynx, esophagus, stomach, and the first part of the small intestine, the duodenum.
During an EGD, the endoscope can be used to:
During an EGD, the endoscope can be used to:
101


