腹腔镜手术治疗胃食管反流病
腹腔镜手术治疗胃食管反流病PATIENT INFORMATION FROM YOUR SURGEON & SAGES
腹 腔 镜 手 术 治 疗 胃 食 管 反 流 病
手术治疗“烧心”
如果你有“烧心”的症状，你的外科医生可能会建议你采用腹腔镜手术治疗这种医学上称为胃食管反流的疾病（GERD）。这本手册将向你介绍这一手术：
1) 什么是胃食管反流病？
2) 胃食管反流病的内科和手术治疗方法选择。
3) 手术是如何进行的？
4) 手术治疗的预期的结果
5) 采用腹腔镜手术治疗胃食管反流病的预期结果
什么是胃食管反流病？
尽管可以经常被用于指各种类型的消化道疾病，但作为一个医学术语，“烧心”其实是指胃食管反流病，即胃酸从胃反流到食管内。“烧心”表现在肋骨之间或者仅仅是颈部的下面有剧烈的烧灼样感觉。这种感觉可能从胸部放射到咽喉部和颈部。在美国境内很多成人患有这种疾病，一个月至少经历一次这种不舒服的烧灼的感觉。胃食管反流病的表现还可能有呕吐、吞咽困难、慢性咳嗽、或者气喘。
胃食管反流病的发生机制是什么？
当你饮食的时候，食物从口经过食管到达胃里。在食管的末端有一个较小的环形肌肉叫做下食管括约肌（LES）。下食管括约肌像是一个单项阀门，允许食物经过这里到胃里去。一般来说，吞咽后下食管括约肌会立刻关闭以防止胃液（含有较高酸性物质含量）反流到食管。当下食管括约肌功能异常，胃酸反流并烧灼到食管末段时就发生了胃食管反流病。胃酸刺激食管，使得食管发炎，产生烧心症状，最后可能损伤食管。
诱发胃食管反流病的因素有哪些？
一些人先天（下食管）括约肌的功能较弱。含脂肪的食物、辛辣的食物、一些种类的药物、穿紧身服装、吸烟、饮酒、剧烈运动以及体位的变化（弯腰或躺下）都可能使下食管括约肌松弛，造成反流。很多胃食管反流病人有食管裂孔疝表现（胃食管反流病的一种常见表现）。有食管裂孔疝的病人可能并没有烧心的症状。
如何治疗胃食管反流病？
胃食管反流病的治疗一般有以下三个步骤：
1.改进生活方式
在大多数情况下，改变饮食习惯或者服用不需要医生处方的抗酸剂可以降低症状发生的频率和程度。减肥、戒烟戒酒、改变饮食习惯和睡眠方式也有助于改善症状。
2.药物治疗
如果改变生活方式后症状仍然不改善就要考虑药物治疗。抗酸剂可以中和胃内的胃酸；另外一些非处方药物可以减少胃酸的产生。这两种药都可以减少病人的症状。处方药可能更有效地减少食管的刺激症状，减轻病情。治疗之前，你应该与你的外科医生讨论治疗的方案。
3.手术
如果改变生活方式和药物治疗后病人的症状没有改善，或者在病人需要持续长期服药才能控制症状情况下， 可以考虑采用手术治疗。手术治疗对胃食管反流病非常有效。
手术方式有三种：腹腔镜手术，开腹手术，以及一种尚处于试验中的治疗方式——内窥镜内治疗胃食管反流术。你需要与你的内科医师、外科医师讨论后再决定是否采用手术治疗以及采取哪种手术方式。
采用腹腔镜手术的好处是什么？
采用腹腔镜手术的好处有：
减轻手术后疼痛
减少住院时间
更快地恢复到正常生活
手术伤口愈合处更美观
你是否适合做腹腔镜手术？
尽管腹腔镜手术治疗胃食管反流病有很多优点，但还是有部分病人不适合做该手术。你应该从你的初级保健医生、胃肠病专家和有腹腔镜手术治疗胃食管反流病经验的外科医生那里得到一个全面的关于该手术技术是否适合你的评估和建议。
手术前需要做哪些准备？
在和你的外科医师评估了潜在的手术风险和好处后，你需要签署书面手术同意手术。
根据病人的年龄以及医疗条件的不同， 手术前准备还应该包括血液检查、医学评估、胸部X线检查和心电图检查。
你的外科医师可能会要求你手术前完全排空结肠和清洗肠道。你可能被要求在手术前的一天或几天里仅仅可以喝清洁的液体代替饮食。
建议你在手术前一天的夜晚或者手术当天的清晨洗个淋浴。
手术前晚间的午夜过后，你不应该吃任何事物、也不应该饮水或者饮用任何饮料（除非外科医生告诉你要在手术当天早晨要服用的药物，可以啜一小口的水用于服药）。
手术前一周要暂时停用阿司匹林（aspirin）、抗凝血剂、抗炎药物（比如治疗关节炎的药物）和大剂量的维生素Ｅ。
手术前两周要停止饮食疗法以及停止使用圣约翰麦汁（St. John’s Wort，也称貫葉連翹）。
手术前要戒烟以及做好其他准备。
腹腔镜手术治疗胃食管反流病是如何进行的？
你需要在手术当天的早晨到达医院。
医疗工作人员会在你的静脉插入一根连接导管的针头。在手术中，通过这个导管实施静脉给药。
通常要进行手术前用药。
手术会在全身麻醉下进行，所以病人在手术中持续几个小时是处于睡眠状态。
手术后你会被送往恢复室直到你完全从麻醉中苏醒过来。
多数病人手术后会被要求留在医院观察一晚或者更长时间（比如几天）。
腹腔镜手术治疗胃食管反流病是如何进行的？
腹腔镜手术治疗胃食管反流病（也称腹腔镜Nissen胃底折叠术）是采取将胃的上端包裹食管下段的方式来加固 食管和胃之间的“阀门”。这有点像热狗外面缠绕面包。
腹腔镜手术中，外科医生会在病人腹部开一个小切口（1/4~1/2英寸大小），然后从切口放入一个套管。腹腔镜从套管内放入手术区域。腹腔镜前端有一个微型攝像機可以将病人内部器官的影像放大并传输到电视屏幕上让手术医生观察。
在充入膨胀气体使得腹部膨胀变大起来后，手术的过程是全程“封闭”进行的。
如果不能使用腹腔鏡，該如何處理？
少量病人因为使用腹腔镜无法看清手术区域或者无法有效的实施手术处理。下列因素可能会增加開腹治療的可能性：
肥胖
曾經做過腹部手術並且留下很深的瘢痕（疤痕）組織
手術中出現嚴重的出血問題
由你的外科醫生在手術前或者在手術當中決定決定是否採用開腹手術。 當你的外科醫生覺得不用腹腔鏡而改用開腹是安全的時候，這種手術決定的改變不屬於手術中的合併症。在決定做出手術方式改成開腹手術的的時候一定要保證病人的安全。
手術後應該注意什麼？
建议病人手术后在家中从事轻微的活动。
手術後疼痛一般比較輕微。病人有時也許需要疼痛治療。
手术后通常不再需要进行其他的抗反流治疗。
一些外科医生会调整病人的饮食：开始时仅仅进食流食，后来逐渐的添加固体食物。手术后你应该向你的外科医生询问你的手术后饮食限制。
你大概会在手術后不久可以恢復日常生活，包括淋浴、駕車、上樓梯、負重、工作以及性生活。
你應該在手術後兩周內與醫生聯繫安排術後隨訪。
手術有副作用吗？
研究显示，绝大多数病人在手术后反流症状得到了显著改善或者症状完全消失。
手术的长期副作用通常少见。
一些病人在手术之后会有暂时的吞咽困难。这一症状会在手术后一至三个月消失。
偶尔，病人需要做内镜下扩张术来扩张食管。极少的情况下需要再做手术。
手术后病人的打嗝和/或呕吐的能力可能受到限制。一些病人反映有胃胀发生。
极少数情况，病人反映手术后他们的症状没有任何改善。
手術中的合併症有哪些？
尽管这一手术被认为是安全的，但就像在其他手术中可能出现合并症一样，采用腹腔镜手术治疗胃食管反流病也可能出现合并症。
合并症可能包括但不限于：
全身麻醉的不良反應
出血
手术中伤害了食道，脾，胃或其他内脏器官
手术伤口，腹腔内，或血液受到感染
其他不太常见的合并症也有可能会发生。
你的外科医生可能会和你讨论这些问题。 他/她还会帮助你比较腹腔镜手术治疗和非手术治疗的风险，并根据比较的结果作出是否采用手术的决定。
什麼時候應該聯繫醫生？
在出現以下情況時一定要聯繫你的個人醫生或者外科醫生：
-持續高熱超過101華氏度（39攝氏度）
-出血
-發生腹部腫脹
-經治療後仍不緩解的疼痛
-持續噁心或嘔吐
- 打寒顫
-持續咳嗽或呼吸急促
- 手術切口有化膿性物質流出
- 手術切口周圍逐漸發紅變大或者惡化
- 你不能夠吃或喝任何液體
[ 本帖最后由 cjf555 于 2008-12-13 15:53 编辑 ] SURGERY FOR "HEARTBURN"
If you suffer from "heartburn" your surgeon may have recommended LAPAROSCOPIC ANTI-REFLUX SURGERY to treat this condition, technically referred to as gastroesophageal reflux disease (GERD).This brochure will explain to you:
1)What gastroesophageal reflux disease (GERD) is
2)Medical and surgical treatment options for GERD
3)How this surgery is performed
4)Expected outcomes
5)What to expect if you choose to have laparoscopic anti-reflux surgery
WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?
Although "heartburn" is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition, stomach acids reflux or "back up" from the stomach into the esophagus.Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck.The feeling may radiate through the chest and into the throat and neck.Many adults in the United States experience this uncomfortable, burning sensation at least once a month.Other symptoms may also include vomiting, difficulty swallowing and chronic coughing or wheezing.
WHAT CAUSES GERD?
When you eat, food travels from your mouth to your stomach through a tube called the esophagus.At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES).The LES acts like a one-way valve, allowing food to pass through intothe stomach.Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices, which have a high acid content, into the esophagus.GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus.This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus.
WHAT CONTRIBUTES TO GERD?
Some people are born with a naturally weak sphincter (LES).For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LES to relax, causing reflux.A hiatal hernia (a common term for GERD) may be present in many patients who suffer from GERD, but may not cause symptoms of heartburn.
HOW IS GERD TREATED?
GERD is generally treated in three progressive steps:
1.LIFE STYLE CHANGES
In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are.Losing weight, reducing or eliminatingsmoking and alcohol consumption, and altering eating and sleeping patterns can also help.
2.DRUG THERAPY
If symptoms persist after these life style changes, drug therapy may be required.Antacids neutralize stomach acids and over-the-counter medications reduce the amount of stomach acid produced.Both may be effective in relieving symptoms.Prescription drugs may be more effective in healing irritation of the esophagus and relieving symptoms.This therapy needs to be discussed with your surgeon.
3.SURGERY
Patients who do not respond well to lifestyle changes or medicationsor thosewho continually require medications to control their symptoms, will have to live with their condition ormay undergo a surgical procedure.Surgery is very effective in treating GERD.
There are procedures being tried, known as Intraluminal Endoscopic Procedures, which are alternatives to laparoscopic and open surgery.You will need to discuss with your surgeon and physician whether you are a candidate for any of these procedures.
WHAT ARE THE ADVANTAGES OF THE LAPAROSCOPIC METHOD?
The advantage of the laparoscopic approach is that it usually provides:
· reduced postoperative pain
· shorter hospital stay
· a faster return to work
· improved cosmetic result
ARE YOU A CANDIATE FOR THE LAPAROSCOPIC METHOD?
Although laparoscopic anti-reflux surgery has many benefits, it may not be appropriate for some patients.Obtain a thorough medical evaluation by a surgeon qualified in laparoscopic anti-reflux surgery in consultation with your primary care physician or Gastroenterologist to find out if the technique is appropriate for you.
WHAT TO EXPECT BEFORE LAPAROSCOPIC ANTI-REFLUX SURGERY:
· After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
· Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
· Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery.You may be requested to drink clear liquids, only, for one or several days prior to surgery.
· It is recommended that you shower the night before or morning of the operation.
· After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon has told you are permissible to take with a sip of water the morning of surgery.
· Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
· Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
· Quit smoking and arrange for any help you may need at home.
WHAT TO EXPECT THE DAY OF SURGERY:You usually arrive at the hospital the morning of the operation.
· A qualified medical staff member will place a small needle/catheter in your vein to dispense medication during surgery.
· Often pre-operative medications are necessary.
· You will be under general anesthesia - asleep - during the operation which may last several hours.
· Following the operation you will be sent to the recovery room until you are fully awake.
· Most patients stay in the hospital the night of surgery and may require additional days in the hospital.
HOW IS LAPAROSCOPIC ANTI-REFLUX SURGERY PERFORMED?
· Laparoscopic anti-reflux surgery (commonly referred to as Laparoscopic Nissen Fundoplication) involves reinforcing the "valve" between the esophagus and the stomach by wrapping the upper portion of the stomach around the lowest portion of the esophagus - much the way a bun wrapsaround a hot dog.
· In a laparoscopic procedure,surgeons use small incisions (1/4 to 1/2 inch) to enter the abdomen through cannulas (narrow tube-like instruments).The laparoscope, which is connected to a tiny video camera, is inserted through the small incision, giving the surgeon a magnified view of the patient's internal organs on a television screen.
· The entire operation is performed "inside" after the abdomen is expanded by inflatinggas into it.
WHAT HAPPENS IF THE OPERATION CANNOT BE PERFORMED OR COMPLETED BY THE LAPAROSCOPIC METHOD?
In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively.Factors that may increase the possibility of converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation.The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation.When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather soundsurgical judgment.The decision to convert to an open procedure is strictly based on patient safety.
WHAT SHOULD I EXPECT AFTER SURGERY?
· Patients are encouraged to engage in light activity while at home after surgery.
· Post operative pain is generally mild although some patients may require prescriptionpain medication.
· Anti-reflux medication is usually not required after surgery.
· Some surgeons modify patients diet after surgery beginning with liquids followed by gradual advance to solid foods.You should ask your surgeon about dietary restrictions immediately after the operation.
· You will probably be able to get back to your normal activities within a short amount of time.These activities include showering, driving, walking up stairs, lifting, workingand engaging in sexual intercourse.
· Calland schedule a follow‑up appointment within 2 weeks after your operation.
ARE THERE SIDE EFFECTS TO THIS OPERATION?
Studies have shown that the vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GERD symptoms.
Long-term side effects to this procedure are generally uncommon.
Some patients develop temporary difficulty swallowing immediately after the operation.This usually resolves within one to three months after surgery.
Occasionally, patients may require a procedure to stretchthe esophagus (endoscopic dilation) or rarely re-operation.
The ability to belch and or vomit may be limited following this procedure.Some patients reportstomach bloating.
Rarely, some patients report no improvement in their symptoms.
WHAT COMPLICATIONS CAN OCCUR?
Although the operation is considered safe, complications may occur as they may occur with any operation.
Complications may include but are not limited to:
adverse reaction to general anesthesia
bleeding
injury to the esophagus, spleen, stomachor internal organs
· infection of the wound, abdomen, or blood.
other less common complications may also occur.
Your surgeon may wish to discuss these with you.(S)He will also help you decide if the risks of laparoscopic anti-reflux surgery are less than non-operative management.
WHEN TO CALL YOUR DOCTOR
Be sure to call your physician or surgeon if you develop any of the following:
- Persistent fever over 101 degrees F (39 C)
- Bleeding
- Increasing abdominal swelling
- Pain that is not relieved by your medications
- Persistent nausea or vomiting
- Chills
- Persistent cough or shortness of breath
- Purulent drainage (pus) from any incision
- Redness surrounding any of your incisions that is worsening or getting bigger
- You are unable to eat or drink liquids 值得推广,我们医院用腹腔镜现在做直肠癌了 中国人民解放军第二炮兵总医院早就开展了，做得很好！
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