尼森术式与图佩特腹腔镜胃底折叠术

Nissen vs Toupet laparoscopic fundoplication.

作者信息

Zornig C, Strate U, Fibbe C, Emmermann A, Layer P

机构信息

Department of General Surgery, Israelitisches Krankenhaus, Orchideenstieg 14, 22297 Hamburg, Germany.

出版信息

Surg Endosc. 2002 May;16(5):758-66. doi: 10.1007/s00464-001-9092-8. Epub 2002 Feb 8.

DOI:10.1007/s00464-001-9092-8

PMID:11997817

Abstract

BACKGROUND

Nissen fundoplication (360 degrees ) is the standard operation for the surgical management of gastroesophageal reflux disease (GERD). To avoid postoperative dysphagia, it has been proposed that antireflux surgery be tailored according to the degree of preexisting esophageal motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and the Toupet procedure (270 degrees ) has been recommended for these patients. We performed a randomized trial to evaluate this tailored concept and to compare the two operative techniques in terms of reflux control and complication rate (dysphagia). Our objective was to determine the impact of preoperative esophageal motility on the clinical and objective outcome, following Toupet vs Nissen fundoplication and to evaluate the success rate of these procedures.

METHODS

From May 1999 until May 2000, 200 patients with GERD were included in a prospective randomized study. After preoperative examinations (clinical interview, endoscopy, 24-h pH study and esophageal manometry), 100 patients underwent either a laparoscopic Nissen (50 with and 50 without motility disorders), or a Toupet procedure (50 with and 50 without motility disorders). Postoperative follow-up after 4 months included clinical interview, endoscopy, 24-h pH study and esophageal manometry.

RESULTS

Interviews showed that 88% (Nissen) and 90% (Toupet) of the patients, respectively, were satisfied with the operative result. Dysphagia was more frequent following a Nissen fundoplication than after a Toupet (30 vs 11, p <0.001) and did not correlate with preoperative motility. In terms of reflux control, the Toupet proved to be as effective as the Nissen procedure.

CONCLUSION

Tailoring antireflux surgery to esophageal motility is not indicated, since motility disorders are not correlated with postoperative dysphagia. The Toupet procedure is the better operation because it has a lower rate of dysphagia and is as effective as the Nissen fundoplication in controlling reflux.

摘要

背景

nissen胃底折叠术（360度）是胃食管反流病（GERD）外科治疗的标准术式。为避免术后吞咽困难，有人提出抗反流手术应根据术前食管动力的程度进行调整。术后吞咽困难被认为在食管动力障碍患者中更常见，对于这些患者推荐采用Toupet手术（270度）。我们进行了一项随机试验，以评估这种个体化理念，并比较这两种手术技术在反流控制和并发症发生率（吞咽困难）方面的差异。我们的目的是确定术前食管动力对Toupet与nissen胃底折叠术后临床和客观结果的影响，并评估这些手术的成功率。

方法

从1999年5月至2000年5月，200例GERD患者被纳入一项前瞻性随机研究。经过术前检查（临床访谈、内镜检查、24小时pH监测和食管测压）后，100例患者接受了腹腔镜nissen手术（50例有动力障碍，50例无动力障碍）或Toupet手术（50例有动力障碍，50例无动力障碍）。术后4个月的随访包括临床访谈、内镜检查、24小时pH监测和食管测压。