Booth M, Stratford J, Dehn T C B
Department of Surgery, Royal Berkshire Hospital, Reading, UK.
Dis Esophagus. 2002;15(1):57-60. doi: 10.1046/j.1442-2050.2002.00229.x.
We evaluated a policy of performing laparoscopic antireflux surgery without tailoring the procedure to the results of preoperative esophageal motility tests. A total of 117 patients (82 with normal esophageal motility; 35 with ineffective motility, IEM) underwent laparoscopic Nissen fundoplication for symptomatic gastroesophageal reflux. There were no significant differences in preoperative symptom length, dysphagia, DeMeester symptom scores, acid exposure times or lower esophageal sphincter pressures between the two groups. Both groups showed postoperative improvements in DeMeester symptom scores, dysphagia and acid exposure, with no differences between groups. At 1 year after surgery, 95% of the normal motility group and 91% of the IEM group had a good/excellent outcome from surgery. None of the IEM group required postoperative dilatation or reoperation. Patients with IEM fare equally well from laparoscopic Nissen fundoplication as those with normal esophageal motility. There is no merit in tailoring antireflux surgery to the results of preoperative motility tests.
我们评估了一项不根据术前食管动力测试结果来调整手术方式而直接进行腹腔镜抗反流手术的策略。共有117例患者（82例食管动力正常；35例动力无效，即IEM）因有症状的胃食管反流接受了腹腔镜Nissen胃底折叠术。两组患者在术前症状持续时间、吞咽困难、DeMeester症状评分、酸暴露时间或食管下括约肌压力方面均无显著差异。两组患者术后的DeMeester症状评分、吞咽困难和酸暴露情况均有改善，组间无差异。术后1年，正常动力组95%的患者和IEM组91%的患者手术效果良好/极佳。IEM组中无一例患者术后需要扩张或再次手术。IEM患者接受腹腔镜Nissen胃底折叠术的效果与食管动力正常的患者相当。根据术前动力测试结果来调整抗反流手术并无益处。
