Abbas Abbas E, Deschamps Claude, Cassivi Stephen D, Allen Mark S, Nichols Francis C, Miller Daniel L, Pairolero Peter C
Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
Ann Thorac Surg. 2004 Feb;77(2):393-6. doi: 10.1016/S0003-4975(03)01352-3.
To review our early operative results and endoscopic findings after laparoscopic fundoplication for Barrett's esophagus (BE).
From January 1995 through December 2000, 49 patients with BE (35 men and 14 women) underwent laparoscopic antireflux surgery. Median age was 54 years (range, 28 to 85 years). No patient had high-grade dysplasia; 6, however, had low-grade dysplasia. All 49 patients had gastroesophageal reflux symptoms. Heartburn was present in 41 patients (84%), dysphagia in 16 (33%), epigastric or chest pain in 9 (18%), and other symptoms in 16 (33%). A Nissen fundoplication was performed in 48 patients and a partial posterior fundoplication in 1. Forty-one patients (84%) had concomitant hiatal hernia repair.
There were no deaths. Complications occurred in 2 patients (4%). Follow-up was complete in 48 patients (98%) and ranged from 1 to 81 months (median, 29 months). Functional results were classified as excellent in 33 patients (69%), good in 9 (19%), fair in 5 (10%), and poor in 1 (2%). Thirty-three patients (67%) underwent postoperative surveillance esophagoscopy with biopsy. Nine patients (18%) had total regression of BE and 3 (6%) had a decrease in total length. In the 6 patients with preoperative low-grade dysplasia, dysplasia was not found in 4, remained unchanged in 1, and progressed to in situ adenocarcinoma in 1.
Laparoscopic fundoplication is effective in controlling symptoms in the majority of patients with BE. While disappearance of BE may occur in some patients, the possibility of developing esophageal adenocarcinoma is not eliminated by laparoscopic fundoplication. Therefore, endoscopic surveillance should continue.
回顾我们对巴雷特食管（BE）行腹腔镜胃底折叠术后的早期手术结果及内镜检查结果。
1995年1月至2000年12月，49例BE患者（男35例，女14例）接受了腹腔镜抗反流手术。中位年龄为54岁（范围28至85岁）。无患者有高级别异型增生；然而，6例有低级别异型增生。所有49例患者均有胃食管反流症状。41例患者（84%）有烧心症状，16例（33%）有吞咽困难，9例（18%）有上腹部或胸痛，16例（33%）有其他症状。48例行nissen胃底折叠术，1例行部分后壁胃底折叠术。41例患者（84%）同时行了食管裂孔疝修补术。
无死亡病例。2例患者（4%）出现并发症。48例患者（98%）获得完整随访，随访时间为1至81个月（中位时间29个月）。功能结果分类为：优33例（69%），良9例（19%），中5例（10%），差1例（2%）。33例患者（67%）术后接受了监测性食管镜检查及活检。9例患者（18%）BE完全消退，3例（6%）全长缩短。术前有低级别异型增生的6例患者中，4例未发现异型增生，1例无变化，1例进展为原位腺癌。
腹腔镜胃底折叠术对大多数BE患者控制症状有效。虽然部分患者BE可能消失，但腹腔镜胃底折叠术并未消除发生食管腺癌的可能性。因此，应继续进行内镜监测。
