Bowrey D J, Peters J H
Department of Surgery, University of Southern California, Los Angeles, CA 90033-4612, USA.
Semin Laparosc Surg. 1999 Dec;6(4):194-212. doi: 10.1053/SLAS00600194.
The introduction of laparoscopic fundoplication has dramatically changed the face of antireflux surgery. Central to the success of laparoscopic fundoplication is careful preoperative patient evaluation and attention to surgical technique. Emerging evidence has questioned the long-term durability of laparoscopic partial fundoplications underscoring the place of laparoscopic Nissen fundoplication as the procedure of choice for most patients. The technique of laparoscopic Nissen fundoplication should incorporate crural closure, complete fundic mobilization by short gastric vessel division, and the creation of a short, loose fundoplication by enveloping the anterior and posterior fundic walls around the esophagus. Relief of typical reflux symptoms can be anticipated in over 90% of patients. The outcome of atypical reflux symptoms is less predictable, on average two thirds of patients benefiting. The cost of laparoscopic fundoplication compares favorably to long-term medical therapy and open fundoplication. Current trends indicate that laparoscopic fundoplication is being used increasingly as an alternative to long-term medical therapy.
腹腔镜胃底折叠术的引入极大地改变了抗反流手术的面貌。腹腔镜胃底折叠术成功的关键在于术前对患者进行仔细评估并注重手术技巧。新出现的证据对腹腔镜部分胃底折叠术的长期耐久性提出了质疑，这突出了腹腔镜nissen胃底折叠术作为大多数患者首选手术方式的地位。腹腔镜nissen胃底折叠术的技术应包括缝合裂孔、通过切断胃短血管实现胃底完全游离，以及将胃底前后壁围绕食管包绕形成一个短而宽松的胃底折叠。超过90%的患者可预期典型反流症状得到缓解。非典型反流症状的改善情况较难预测，平均三分之二的患者会从中受益。腹腔镜胃底折叠术的费用与长期药物治疗和开放式胃底折叠术相比具有优势。当前趋势表明，腹腔镜胃底折叠术正越来越多地被用作长期药物治疗的替代方法。
