Holzinger F, Banz M, Tscharner G G, Merki H, Müller E, Klaiber C
Chirurgische Abteilung, Spital Aarberg, Schweiz.
Chirurg. 2001 Jan;72(1):6-13.
A variety of laparoscopic antireflux operations exist for patients with gastroesophageal reflux diseases (GERD). Most surgeons operate using the concept of "tailored approach", which depends on esophageal motility. We have abandoned this concept because of the relatively high incidence of wrap-related complications in patients treated with laparoscopic Nissen fundoplication compared with patients treated with partial fundoplication. It is our policy to perform laparoscopic Toupet partial fundoplication in all patients suffering from GERD, independent of their esophageal motility.
In a prospective trial we have assessed and evaluated our 1-year results of the first 100 consecutive patients treated with Toupet partial fundoplication. All patients underwent esophagogastroscopy and 24-h pH manometry before operation. One third of patients (n = 34) underwent control manometry 8 weeks postoperatively. The patients were followed up clinically 1, 2, 6 and 12 months postoperatively.
In this study group we achieved a healing rate in GERD of 97%. In 3% of patients GERD recurred. The median clinical DeMeester score decreased from 4.27 +/- 1.5 points preoperatively to 0.25 +/- 0.5 points 1 year postoperatively (P < 0.0005). The median fractional time with pH < 4 decreased from 17.8% +/- 12.5% preoperatively to 0.9% +/- 1.2% 8 weeks postoperatively (P < 0.0005). Because of persistent dysphagia 5% of our patients required postoperative dilatation therapy. The rate of reoperation and mortality was 0%. The total morbidity rate was 18%. In 50% of patients with preoperatively recorded esophageal motility disorder, an improvement of esophageal motility was found postoperatively.
Our 1-year results encourage us to continue to perform laparoscopic Toupet partial fundoplication as the primary repair in all GERD patients, independent of their esophageal motility. Laparoscopic Toupet partial fundoplication has proven to be a safe and highly successful therapeutic option in these patients.
对于胃食管反流病（GERD）患者，有多种腹腔镜抗反流手术可供选择。大多数外科医生采用“个体化方法”的理念进行手术，该理念取决于食管动力。由于与部分胃底折叠术治疗的患者相比，接受腹腔镜Nissen胃底折叠术治疗的患者中与胃底包裹相关并发症的发生率相对较高，我们摒弃了这一理念。我们的策略是，对所有GERD患者均实施腹腔镜Toupet部分胃底折叠术，而不考虑其食管动力情况。
在一项前瞻性试验中，我们评估并分析了连续100例接受Toupet部分胃底折叠术患者的1年随访结果。所有患者在手术前均接受了食管胃镜检查和24小时pH值监测。三分之一的患者（n = 34）在术后8周接受了对照测压。患者在术后1、2、6和12个月进行了临床随访。
在该研究组中，GERD的治愈率达到了97%。3%的患者GERD复发。临床DeMeester评分中位数从术前的4.27±1.5分降至术后1年的0.25±0.5分（P < 0.0005）。pH值< 4的中位分数时间从术前的17.8%±12.5%降至术后8周的0.9%±1.2%（P < 0.0005）。由于持续性吞咽困难，5%的患者需要术后扩张治疗。再次手术率和死亡率为0%。总发病率为18%。在术前记录有食管动力障碍的患者中，50%在术后发现食管动力有所改善。
我们的1年随访结果促使我们继续将腹腔镜Toupet部分胃底折叠术作为所有GERD患者的主要修复手术，而不考虑其食管动力情况。腹腔镜Toupet部分胃底折叠术已被证明是这些患者一种安全且非常成功的治疗选择。
