Chrysos Emmanuel, Tsiaoussis John, Zoras Odysseus John, Athanasakis Elias, Mantides Apostolos, Katsamouris Asterios, Xynos Evaghelos
Unit of Gastrointestinal Surgery and the Laboratory of Gastrointestinal Motility, University Hospital of Heraklion, Medical School, University of Crete, Greece.
J Am Coll Surg. 2003 Jul;197(1):8-15. doi: 10.1016/S1072-7515(03)00151-0.
It has been proposed that partial fundoplication is associated with less incidence of postoperative dysphagia and consequently is more suitable for patients with gastroesophageal reflux disease (GERD) and impaired esophageal body motility. The aim of this study was to assess whether outcomes of Toupet fundoplication (TF) are better than those of Nissen-Rossetti fundoplication (NF) in patients with GERD and low-amplitude esophageal peristalsis.
Thirty-three consecutive patients with proved GERD and amplitude of peristalsis at 5 cm proximal to lower esophageal sphincter (LES) less than 30 mmHg were randomly allocated to undergo either TF (19 patients: 11 men, 8 women; mean age: 61.7 +/- 8.7 SD years) or NF (14 patients: 7 men, 7 women; mean age: 59.2 +/- 11.5 years), both by the laparoscopic approach. Pre- and postoperative assessment included clinical questionnaires, esophageal radiology, esophageal transit time study, endoscopy, stationary manometry, and 24-hour ambulatory esophageal pH testing.
Duration of operation was significantly prolonged in the TF arm (TF: 90 +/- 12 minutes versus NF: 67 +/- 15 minutes; p < 0.001). At 3 months postoperatively, the incidences of dysphagia (grades I, II, III) and gas-bloat syndrome were higher after NF than after TF (NF: 57% versus TF: 16%; p < 0.01 and NF: 50% versus TF: 21%; p = 0.02, respectively), but decreased to the same level in both groups at the 1-year followup (NF: 14% versus TF: 16% and NF: 21% versus TF: 16%, respectively). At 3 months postoperatively, patients with NF presented with significantly increased LES pressure than those with TF (p = 0.02), although LES pressure significantly increased after surgery in both groups, as compared with preoperative values. Amplitude of esophageal peristalsis at 5 cm proximal to LES increased postoperatively to the same extent in both groups (TF, preoperatively: 21 +/- 6 mmHg versus postoperatively: 39 +/- 12 mmHg; p < 0.001, and NF, preoperatively: 20 +/- 8 mmHg versus postoperatively: 38 +/- 12 mmHg; p < 0.001). Reflux was abolished in all patients of both groups.
Both TF and NF efficiently control reflux in patients with GERD and low amplitude of esophageal peristalsis. Early in the postoperative period, TF is associated with fewer functional symptoms, although at 1 year after surgery those symptoms are reported at similar frequencies after either procedure.
有人提出，部分胃底折叠术与术后吞咽困难发生率较低相关，因此更适合患有胃食管反流病（GERD）且食管体部蠕动受损的患者。本研究的目的是评估在GERD和食管低幅度蠕动的患者中，图佩特胃底折叠术（TF）的效果是否优于nissen - 罗塞蒂胃底折叠术（NF）。
连续33例经证实患有GERD且食管下括约肌（LES）近端5 cm处蠕动幅度小于30 mmHg的患者被随机分配接受TF（19例患者：11例男性，8例女性；平均年龄：61.7±8.7标准差岁）或NF（14例患者：7例男性，7例女性；平均年龄：59.2±11.5岁），均通过腹腔镜手术。术前和术后评估包括临床问卷、食管放射学检查、食管通过时间研究、内镜检查、静态测压和24小时动态食管pH测试。
TF组手术时间显著延长（TF：90±12分钟 vs NF：67±15分钟；p < 0.001）。术后3个月，NF术后吞咽困难（I、II、III级）和气胀综合征的发生率高于TF（NF：57% vs TF：16%；p < 0.01，NF：50% vs TF：21%；p = 0.02），但在1年随访时两组降至相同水平（NF：14% vs TF：16%，NF：21% vs TF：16%）。术后3个月，NF患者的LES压力比TF患者显著升高（p = 0.02），尽管两组术后LES压力与术前值相比均显著升高。LES近端5 cm处食管蠕动幅度在两组术后均有相同程度的增加（TF，术前：21±6 mmHg vs 术后：39±12 mmHg；p < 0.001，NF，术前：20±8 mmHg vs 术后：38±12 mmHg；p < 0.001）。两组所有患者的反流均得到消除。
TF和NF均可有效控制GERD和食管低幅度蠕动患者的反流。术后早期，TF与较少的功能症状相关，尽管术后1年两种手术报告的这些症状频率相似。
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