Khoursheed M A, Al-Asfoor M, Al-Shamali M, Ayed A K, Gupta R, Dashti H M, Behbehani A I
Department of Surgery, Mubarak Al-Kabeer Hospital, Faculty of Medicine, Kuwait University.
Ann R Coll Surg Engl. 2001 Jul;83(4):229-34.
Gastro-oesophageal reflux (GERD) is a common condition. Many patients respond to conservative therapy. Severe symptomatic cases and those who fail medical treatment are referred to surgery. The long-term results of open fundoplication surgery have been good with a more than 90% response after 10 years of follow-up. The introduction of laparoscopic fundoplication achieved the same results with shorter hospital stay, a better cosmetic result and less cost to the health care providers.
74 patients who failed medical treatment for GERD were treated by laparoscopic fundoplication. The Toupet procedure was performed in 66 of these patients, the others patients had a Nissen-type fundoplication. The patients were followed up for a mean period (+/- SD) of 14.8 +/- 8.8 months (range 3-33 months).
Most of the patients were males (n = 65). The mean age (+/- SD) of all the patients was 36.1 +/- 9.5 years (range 17-60 years). The majority (93.8%) reported disappearance of symptoms and are not using any antireflux medications. Five patients (6.7%) are considered failures of the procedures. Of these, three patients developed recurrence of reflux symptoms during the follow-up period. The other two patients developed complications, i.e. gas bloat, persistent vomiting and dysphagia which warranted taking down the wraps laparoscopically. Two patients developed a small incisional hernia at the site of the 10 mm port. The mean of hospital stay (+/- SD) was 3.1 +/- 1.3 days (range 1-7 days).
Laparoscopic fundoplication is safe and effectively relieves reflux symptoms in patients who fail medical treatment.
胃食管反流（GERD）是一种常见病症。许多患者对保守治疗有反应。症状严重的病例以及药物治疗失败的患者会被转诊进行手术。开放型胃底折叠术的长期效果良好，随访10年后有效率超过90%。腹腔镜胃底折叠术的应用取得了相同的效果，且住院时间更短、美容效果更好，对医疗服务提供者而言成本更低。
74例GERD药物治疗失败的患者接受了腹腔镜胃底折叠术。其中66例患者采用了图佩特手术，其他患者采用了nissen型胃底折叠术。对患者进行了平均14.8±8.8个月（范围3 - 33个月）的随访。
大多数患者为男性（n = 65）。所有患者的平均年龄（±标准差）为36.1±9.5岁（范围17 - 60岁）。大多数（93.8%）患者报告症状消失，且不再使用任何抗反流药物。5例患者（6.7%）被认为手术失败。其中，3例患者在随访期间出现反流症状复发。另外2例患者出现并发症，即气胀、持续性呕吐和吞咽困难，需要通过腹腔镜拆除包裹物。2例患者在10毫米端口处出现小切口疝。平均住院时间（±标准差）为3.1±1.3天（范围1 - 7天）。
腹腔镜胃底折叠术对于药物治疗失败的患者安全且能有效缓解反流症状。
