背景:腔内功能性管腔成像探针(EndoFLIP)可实时评估胃底折叠术期间胃食管交界处(GEJ)的顺应性。鉴于希尔手术期间EndoFLIP测量数据有限,与Toupet胃底折叠术相比,我们调查了Hill手术对GEJ依从性的影响.
方法:包括在2017年至2022年期间接受机器人Hill或Toupet胃底折叠术并进行术中EndoFLIP的患者。GEJ的EndoFLIP测量包括横截面面积(CSA),球囊内压力,高压区长度(HPZ),扩张性指数(DI),和合规。主观性反流症状,胃食管反流病-健康相关生活质量(GERD-HRQL)评分,术前以及短期和长期随访时评估吞咽困难评分.
结果:一百五十四名患者(71.9%)进行了Toupet胃底折叠术,而60名(28%)患者接受了Hill手术。CSA[27.7±10.9mm2vs42.2±17.8mm2,p<0.0001],压力[29.5±6.2mmHg对33.9±8.5mmHg,p=0.0009],DI[0.9±0.4mm2/mmHgvs1.3±0.6mm2/mmHg,p=0.001],和符合性[25.9±12.8mm3/mmHgvs35.4±13.4mm3/mmHg,与Toupet相比,Hill手术后p=0.01]较低。然而,胃底折叠术后HPZ在手术之间没有差异[Hill:2.9±0.4cm,行程:3.1±0.6cm,p=0.15]。随访显示GERD-HRQL评分无显著差异,总体吞咽困难评分或不典型症状组间比较(p>0.05)。
结论:尽管CSA较低,但Hill手术对Toupet胃底折叠手术治疗胃食管反流病(GERD)同样有效,DI,以及希尔程序后的合规性。两种手术均导致DI<2mm2/mmHg,手术后(12-24)个月的吞咽困难报告无显着差异。仍有必要进行进一步的研究,以阐明术后吞咽困难发展的DI临界值。
Endoluminal functional lumen imaging probe (
EndoFLIP) provides a real-time assessment of gastroesophageal junction (GEJ) compliance during fundoplication. Given the limited data on
EndoFLIP measurements during the Hill procedure, we investigated the impact of the Hill procedure on GEJ compliance compared to Toupet fundoplication.
Patients who underwent robotic Hill or Toupet fundoplication with intraoperative
EndoFLIP between 2017 and 2022 were included.
EndoFLIP measurements of the GEJ included cross sectional surface area (CSA), intra-balloon pressure, high pressure zone length (HPZ), distensibility index (DI), and compliance. Subjective reflux symptoms, gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, and dysphagia score were assessed pre-operatively as well as at short- and longer-term follow-up.
One-hundred and fifty-four patients (71.9%) had a Toupet fundoplication while sixty (28%) patients underwent the Hill procedure. The CSA [27.7 ± 10.9 mm2 vs 42.2 ± 17.8 mm2, p < 0.0001], pressure [29.5 ± 6.2 mmHg vs 33.9 ± 8.5 mmHg, p = 0.0009], DI [0.9 ± 0.4 mm2/mmHg vs 1.3 ± 0.6 mm2/mmHg, p = 0.001], and compliance [25.9 ± 12.8 mm3/mmHg vs 35.4 ± 13.4 mm3/mmHg, p = 0.01] were lower after the Hill procedure compared to Toupet. However, there was no difference in post-fundoplication HPZ between procedures [Hill: 2.9 ± 0.4 cm, Toupet: 3.1 ± 0.6 cm, p = 0.15]. Follow-up showed no significant differences in GERD-HRQL scores, overall dysphagia scores or atypical symptoms between groups (p > 0.05).
The Hill procedure is as effective to the Toupet fundoplication in surgically treating gastroesophageal reflux disease (GERD) despite the lower CSA, DI, and compliance after the Hill procedure. Both procedures led to DI < 2 mm2/mmHg with no significant differences in dysphagia reporting (12-24) months after the procedure. Further studies to elucidate a cutoff value for DI for postoperative dysphagia development are still warranted.