Awad Z T, Filipi C J, Mittal S K, Roth T A, Marsh R E, Shiino Y, Tomonaga T
Department of Surgery, Creighton University School of Medicine, Suite 3740, 601 N. 30th Street, Omaha, NE 68131, USA.
Surg Endosc. 2000 May;14(5):508-12. doi: 10.1007/s004640000091.
Laparoscopic antireflux surgery is the procedure of choice for gastroesophageal reflux disease (GERD). However, many clinicians have reservations about its application in patients with complicated GERD, notably those with esophageal shortening. In this report, we present our experience with the laparoscopic management of the shortened esophagus. A total of 235 patients with primary GERD underwent laparoscopic antireflux procedures, 38 of whom were suspected preoperatively to have a shortened esophagus. Of the 235 patients, 8 (3.4%) needed a left thoracoscopically assisted gastroplasty in addition to laparoscopic Toupet repair (n = 4) or Nissen fundoplication (n = 4). Complications included pleural effusion (n = 1), pneumothorax (n = 2), and minor atelectasis (n = 1). The average hospital stay was 3 days. Results were satisfactory in 7 of 8 patients, with a mean follow-up of 20.2 months (range, 9-34 months). The surgical management of the shortened esophagus is difficult. However, the role of minimally invasive techniques is justified. Early results are appealing, with less morbidity, satisfactory control of GERD related symptoms, and a shortened hospital stay.
腹腔镜抗反流手术是治疗胃食管反流病（GERD）的首选术式。然而，许多临床医生对其在复杂GERD患者中的应用，尤其是食管缩短患者中应用持保留态度。在本报告中，我们介绍了腹腔镜治疗食管缩短的经验。共有235例原发性GERD患者接受了腹腔镜抗反流手术，其中38例术前怀疑食管缩短。在这235例患者中，8例（3.4%）除了接受腹腔镜Toupet修补术（n = 4）或Nissen胃底折叠术（n = 4）外，还需要左胸腹腔镜辅助胃成形术。并发症包括胸腔积液（n = 1）、气胸（n = 2）和轻度肺不张（n = 1）。平均住院时间为3天。8例患者中有7例结果满意，平均随访20.2个月（范围9 - 34个月）。食管缩短的手术治疗具有挑战性。然而，微创技术的作用是合理的。早期结果令人满意，发病率较低，GERD相关症状控制良好，住院时间缩短。
