Mastrorilli M, Benassai G, Quarto G, Cantelmo A, Pastore M, Mastrorilli G
Facoltà di Medicina e Chirurgia, Dipartimento di Chirurgia Generale, Oncologia e Videoassistita, Università degli Studi di Napoli, Federico II, Napoli, Italy.
Minerva Chir. 2002 Oct;57(5):635-40.
The purpose of this study is to report personal experience in laparoscopic antireflux surgery and to analyze the clinical and functional outcomes of this procedure, also in relation to the different techniques used.
From 1996 to 2000, 20 patients with gastroesophageal reflux disease associated with hiatal hernia underwent laparoscopic surgery. The indication for surgery was failure of long-term medical therapy. All patients had severe acid reflux on 24 hrs-pH monitoring, endoscopic evidence of esophagitis and hiatal hernia, and defective lower esophageal sphincter. A Nissen fundoplication was performed in 13 patients with normal esophageal body motility, and a 270 degrees posterior fundoplication in seven patients with low esophageal motility.
Mortality and conversion rate were 0. Mean operative time was 135 min and mean postoperative hospital stay 5 days. Operative morbidity was 15%. All the patients were completely cured of reflux symptoms; transient mild postoperative dysphagia occurred in two patients (10%). There was a significantly improvement of the results in postoperative esophageal manometry and 24 hrs-pH monitoring.
This preliminary experience suggests that laparoscopic surgery represents a safe and effective procedure for the treatment of gastroesophageal reflux disease. Precise selection of patients and adequate surgical technique are essential.
本研究旨在报告腹腔镜抗反流手术的个人经验，并分析该手术的临床及功能结果，同时探讨其与所采用的不同技术之间的关系。
1996年至2000年间，20例患有与食管裂孔疝相关的胃食管反流病患者接受了腹腔镜手术。手术指征为长期药物治疗失败。所有患者24小时pH监测显示有严重酸反流，内镜检查有食管炎及食管裂孔疝证据，且食管下括约肌功能不全。13例食管体部蠕动正常的患者接受了nissen胃底折叠术，7例食管蠕动减弱的患者接受了270度后壁胃底折叠术。
死亡率和中转开腹率均为0。平均手术时间为135分钟，平均术后住院时间为5天。手术并发症发生率为15%。所有患者的反流症状均完全治愈；2例患者（10%）术后出现短暂轻度吞咽困难。术后食管测压和24小时pH监测结果有显著改善。
这一初步经验表明，腹腔镜手术是治疗胃食管反流病的一种安全有效的方法。精确选择患者和采用恰当的手术技术至关重要。
