Heikkinen T J, Haukipuro K, Bringman S, Ramel S, Sorasto A, Hulkko A
Department of Surgery, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland.
Surg Endosc. 2000 Nov;14(11):1019-23. doi: 10.1007/s004640000261.
Laparoscopic operation has replaced the conventional open procedure in the treatment of gastroesophageal reflux disease (GERD) in spite of the fact that long-term results based on controlled clinical trials have been lacking. The objective of this study was to compare outcome, quality of life, and patient satisfaction after laparoscopic and open Nissen fundoplication in a community hospital setting with a 2-year follow-up.
Forty-two patients with GERD were randomized to either laparoscopic (LNF) or open (ONF) Nissen fundoplication. Outcome evaluation included reflux symptoms, gastrointestinal quality of life (GIQLI), and upper GI endoscopy.
Esophagitis was cured among all patients in the LNF group and in 90% of the ONF group. There were two patients (10%) in both groups who had medicine-dependent recurrent reflux together with significant worsening in the GIQLI scores. One patient in the LNF group has been reoperated due to a suture granuloma in the left epigastric port. Two patients in the LNF group needed esophageal dilatation due to persistent dysphagia. GIQLI scores (scale, 0-144) were equally normalized in both groups. Overall, 90% in the LNF and 100% in the ONF group were either satisfied or very satisfied with the operation. There was only one patient (LNF) who would not choose to have the operation again.
Laparoscopic and open Nissen fundoplication seem to be equally effective methods for improving reflux symptoms and quality of life, resulting in a high rate of satisfaction among patients with an intermediate follow-up period of 2 years.
尽管缺乏基于对照临床试验的长期结果，但腹腔镜手术已取代传统开放手术用于治疗胃食管反流病（GERD）。本研究的目的是比较在社区医院环境中进行腹腔镜和开放Nissen胃底折叠术并随访2年的疗效、生活质量和患者满意度。
42例GERD患者被随机分为腹腔镜Nissen胃底折叠术（LNF）组或开放Nissen胃底折叠术（ONF）组。疗效评估包括反流症状、胃肠道生活质量（GIQLI）和上消化道内镜检查。
LNF组所有患者及ONF组90%的患者食管炎得到治愈。两组均有2例患者（10%）药物依赖型反流复发，且GIQLI评分显著恶化。LNF组1例患者因左上腹端口缝线肉芽肿接受了再次手术。LNF组2例患者因持续性吞咽困难需要进行食管扩张。两组的GIQLI评分（范围0 - 144）均恢复正常。总体而言，LNF组90%、ONF组100%的患者对手术感到满意或非常满意。只有1例患者（LNF组）表示不会再次选择进行该手术。
腹腔镜和开放Nissen胃底折叠术似乎是改善反流症状和生活质量的等效方法，在2年的中期随访期内患者满意度较高。
