복강경 위저추벽성형술로 치유한 위식도 역류질환 3예 = Three Cases of Gastroesophageal Reflux Disease Treated by Laparoscopic Fundoplication

국문 초록 (Abstract)

위식도역류질환은 위식도역류로 인해 증상이 있거나 신체적인 합병증이 발생할 위험성이 있는 경우를 말한다. 치료로서는 현재 약물치료가 주를 이루고 있으며, 히스타민-2 수용체 길항제, 양성자 펌프 억제제, 제산제는 위내 산도를 감소시켜 산역류를 감소시키는 역할을 하지만 약물을 복용 중지할 경우 재발률이 매우 높다. 이에 반해, 위식도역류질환의 수술적 치료방법으로 시도되고 있는 위저추벽성형술은 위식도 접합부의 생리학적인 재건을 통해 위식도역류의 원인을 교정하는 것을 목표로 하고 있다. 그러나 위저추벽성형술은 침습적 치료방법이기에 약간의 위험성이 있고 이러한 위험성을 최소화하기 위해 복강경을 통한 위저추벽성형술이 시도되고 있다. 수술 이후 생길 수 있는 합병증으로는 연하곤란, 복부 팽만감, 방귀가 잦아지는 증상 등이 있다. 저자 등은 위식도 역류질환을 가진 3예(약물 치료에 반응은 있었지만 장기적인 약물 치료를 거부한 1예, 식도열공 헤르니아를 동반한 1예, 약물 치료에 반응하지 않은 1예에서 복강경을 이용하여 270o 위저추벽성형술을 시행하여 위식도역류질환이 치유된 경험을 하였기에 문헌 고찰과 함께 보고하는 바이다.

다국어 초록 (Multilingual Abstract)

Medical treatment so far takes the major portion in the treatment of gastroesophageal reflux disease (GERD). Histamine-2 receptor antagonists, proton pump inhibitors and antacids, which are used in the medical treatment of GERD, decreases intragastric acidity, and therefore decreases acid reflux. However, recurrences are frequently observed after the cessation of medication. On the other hand, fundoplication, the surgical management of GERD, aims for physiologic reconstruction of esophagogastric junction, and for correcting the pathogenetic cause of GERD. But fundoplication is linked to risks related to surgery and general anesthesia. Laparoscopic funcoplication minimizes these risks. We recently experienced three cases of GERD improved by laparoscopic 270o fundoplication. One patient was intolerant of long-term proton pump inhibitor treatment, and two patients had hiatal hernia, and one of them showed failure to medical treatment. This report describes these three cases with a brief review of literatures survey.

참고문헌 (Reference)

• 1 "위식도 역류질환의 진단과 치료" 46 : 1025-1032, 2003
• 2 "열공 헤르니아가 동반된 역류성 식도염을 벨시-마크(Belsey Mark IV)수술로 치유한 1예" 9 : 155-158, 2003
• 3 "역류성 식도염 치료에 대한 양자펌프 억제제와 ranitidine 사용의 비용-효과 분석" 62 : 504-512, 2002
• 4 "flexible endoscopic suturing for treatment of GERD" a multicenter trial 416-422, gastrointestendosc2001
• 5 "Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.The Practice Parameters Committee of the American College of Gastroenterology" 94 : 1434-1442, 1999
• 6 "The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication:prospective evaluation of 100 patients with 'typical' symptoms" 228 : 40-50, 1998
• 7 "The cost of long term therapy for gstro-oesophageal reflux disese:a randomized trial comparing omeprazole and open antireflux surgery" 49 : 488-494, 2001
• 8 "Sleigsenger and Fordtran's gastrointestinal and liver disease." 599-1 622, 2002
• 9 "Radiofrequency energy delivery to the gastroesophageal junction for the tratment of GERD" 53 : 407-415, 2001
• 10 "Prevention of recurrences of erosive reflux esophagitis:a cost-effectiveness analysis of maintenance proton pump inhibition" 102 : 78-88, 1997
• 11 "Partial fundoplications for gstroesophageal reflux disease:indications and current status" 29 : 127-132, 1999
• 12 "Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease:follow-up of a randomized controlled trial" 285 : 2331-2338, 2001
• 13 "Laparoscopic fundoplication is the treatment of choice for gastro-oesophageal reflux disease" 51 : 468-471, 2002
• 14 "Laparoscopic Nissen funcoplication:where do we stand" 7 : 17-21, 1997
• 15 "Influence of pathophysiology and cost on the medical management of gstroesophageal reflux disease" 3-, amjhealthsystpharm1996
• 16 "Does oesophageal motor function improve with time after successful antireflux surgery Results of a prospective" 82-86,
• 17 "Continued(5-year)followup of a randomized clinical study comparing antireflux surgery and omeparzole in gastroesophageal reflux disease" 192 : 172-181, 2001
• 18 "Bowel dysfunction after laparoscopic antireflux surgery:incidence,severity,and clinical course" 114 : 6-9, 2003
• 19 "An evidence-based appraisal of reflux disease management-the Genval Workshop Report" 44 : 1999