Puhalla H, Lenglinger J, Bischof G, Miholic J, Függer R, Stacher G
Klinische Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, Wien, Osterreich.
Chirurg. 2002 Mar;73(3):230-4. doi: 10.1007/s00104-001-0418-9.
A Nissen fundoplication for gastrooesophageal reflux disease may more often lead to persistent dysphagia than a Toupet fundoplication. The aim of this study was to assess the results of laparoscopic Nissen versus Toupet fundoplication in patients with reflux disease and impaired distal esophageal motility.
In 15 patients a laparoscopic Nissen and in 17 a laparoscopic Toupet fundoplication was carried out. Criteria for an impaired motility of the distal esophagus were a mean amplitude of < 30 mm Hg of swallow-induced contractions, or > 33% non-propulsive or non-transmitted contraction waves. Before surgery, heartburn, dysphagia, regurgitation and other symptoms were scored and endoscopic, manometric and 24 hour pH-metric investigations performed. Patients were reinvestigated 3 to 30 (median 15) months after Nissen and 3 to 42 (median 7) months after Toupet fundoplication.
After Nissen as well as after Toupet fundoplication heartburn was significantly less frequent, whereas dysphagia and all other symptom-scores remained unchanged. In the 26 patients reinvestigated manometrically, the resting pressure of the lower esophageal sphincter was significantly higher following both operations and the residual sphincter pressure upon swallowing higher only after Nissen fundoplication. The amplitude of swallow-induced contractions and the percentages of non-propulsive and non-transmitted contraction waves were not significantly changed after either operation. In the 23 patients restudied pH-metrically, reflux activity was significantly reduced after both Nissen and Toupet fundoplication.
In patients with reflux disease and impaired distal esophageal motility, laparoscopic Nissen and Toupet fundoplication both yielded satisfactory results and neither operation led to increased dysphagia.
与 Toupet 胃底折叠术相比，用于治疗胃食管反流病的 Nissen 胃底折叠术更常导致持续性吞咽困难。本研究的目的是评估腹腔镜 Nissen 胃底折叠术与 Toupet 胃底折叠术治疗反流病且食管远端动力受损患者的效果。
对 15 例患者实施了腹腔镜 Nissen 胃底折叠术，对 17 例患者实施了腹腔镜 Toupet 胃底折叠术。食管远端动力受损的标准为吞咽诱发收缩的平均幅度<30 mmHg，或非推进性或非传导性收缩波>33%。手术前，对烧心、吞咽困难、反流及其他症状进行评分，并进行内镜、测压及 24 小时 pH 监测检查。在 Nissen 胃底折叠术后 3 至 30 个月（中位数 15 个月）以及 Toupet 胃底折叠术后 3 至 42 个月（中位数 7 个月）对患者进行复查。
Nissen 胃底折叠术和 Toupet 胃底折叠术后烧心的频率均显著降低，而吞咽困难及所有其他症状评分均未改变。在 26 例接受测压复查的患者中，两种手术术后食管下括约肌的静息压力均显著升高，仅在 Nissen 胃底折叠术后吞咽时的残余括约肌压力更高。两种手术术后吞咽诱发收缩的幅度以及非推进性和非传导性收缩波的百分比均无显著变化。在 23 例接受 pH 监测复查的患者中，Nissen 胃底折叠术和 Toupet 胃底折叠术后反流活动均显著降低。
对于反流病且食管远端动力受损的患者，腹腔镜 Nissen 胃底折叠术和 Toupet 胃底折叠术均取得了满意的效果，且两种手术均未导致吞咽困难增加。
