Meier C, Niedermann F, Wehrli H
Chirurgische Klinik, Schwerpunktspital Wetzikon.
Schweiz Med Wochenschr. 2000 Oct 7;130(40):1399-406.
Chronic gastrooesophageal reflux disease (GERD) is the most common benign pathology of the upper gastrointestinal tract in the western world. We report our experience of laparoscopic antireflux surgery.
49 patients underwent laparoscopic antireflux surgery at our clinic between 1994 and 1999. 48 patients were followed up in a retrospective study. Mean follow-up was 30 months (2-66). 31 patients (64.6%) were male and 17 female (35.4%). Mean age was 48 years (26-74). The surgical method was tailored to the case: total Nissen fundoplication (87.5%) was indicated after ruling out oesophageal motility disorders by manometry. In 6 patients (12.5%) with coexisting dysphagia or pathological manometry, partial posterior fundoplication (Toupet) was performed.
Mean operating time of 215 minutes (125-420) for the first 10 Nissens was significantly reduced to 119 minutes (70-190) for the last 10 procedures with increasing experience of the surgeon. No severe intraoperative complications occurred and mortality was 0%. Conversion rate was 4.2%. Mean hospital stay was 6.1 days (1-36). At follow-up 93.7% were free of reflux symptoms without medication, and only one patient (2.1%) suffered from regular reflux which had to be treated with PPI daily. 2 patients (4.2%) took PPI only occasionally. Persistent dysphagia occurred in 7 patients (14.8%). 5 (10.5%) underwent one or more endoscopic dilatations, after which 3 patients (6.3%) reported an improvement of dysphagia. No patient needed reoperation on due to mechanical complications. 1 patient (2.1%) developed a paraoesophageal hernia 4.5 years after a Nissen procedure. According to the Visick Score, 95.8% of all patients were satisfied with their outcome (Visick I/II).
With careful investigation and indication, laparoscopic antireflux surgery is a safe and effective alternative method to long-term medication with PPI in the treatment of gastrooesophageal reflux disease. Morbidity is low. Persistent postoperative dysphagia can be reduced with either a short and floppy total fundoplication or a partial wrap.
慢性胃食管反流病（GERD）是西方世界上消化道最常见的良性疾病。我们报告我们的腹腔镜抗反流手术经验。
1994年至1999年间，49例患者在我们诊所接受了腹腔镜抗反流手术。对48例患者进行了回顾性研究。平均随访时间为30个月（2至66个月）。男性31例（64.6%），女性17例（35.4%）。平均年龄48岁（26至74岁）。手术方法根据具体情况而定：通过测压排除食管动力障碍后，87.5%的患者行全胃底折叠术（Nissen术）。6例（12.5%）伴有吞咽困难或测压异常的患者行部分胃底后折叠术（Toupet术）。
随着外科医生经验的增加，前10例Nissen术的平均手术时间为215分钟（125至420分钟），最后10例手术显著缩短至119分钟（70至190分钟）。术中无严重并发症发生，死亡率为0%。中转率为4.2%。平均住院时间为6.1天（1至36天）。随访时，93.7%的患者无需药物治疗即无反流症状，仅1例患者（2.1%）有规律性反流，需每日用质子泵抑制剂（PPI）治疗。2例患者（4.2%）偶尔服用PPI。7例患者（14.8%）出现持续性吞咽困难。5例（10.5%）接受了一次或多次内镜扩张，其中3例患者（6.3%）报告吞咽困难有所改善。无患者因机械性并发症需要再次手术。1例患者（2.1%）在Nissen术后4.5年发生食管旁疝。根据Visick评分，95.8%的患者对手术结果满意（Visick I/II级）。
经过仔细的检查和严格的适应证选择，腹腔镜抗反流手术是治疗胃食管反流病的一种安全有效的替代方法，可替代长期使用PPI药物治疗。发病率低。采用短而宽松的全胃底折叠术或部分胃底折叠术可减少术后持续性吞咽困难的发生。
