Barrat C, Cueto Rozon R, Catheline J M, Rizk N, Champault G
Université Paris XIII-UFR de Bobigny-Bondy, France.
Chirurgia (Bucur). 2000 Jul-Aug;95(4):325-33.
The laparoscopic treatment for gastroesophageal reflux disease (GERD) by partial (PF) or total (TF) fundoplication is the current surgical treatment of choice after failure of appropriate medical treatment. The overall results with fundoplication include the initial learning period during which the rate of complications, and failures are assumed to be greater. The aim of this study was to compare the results of laparoscopic treatment for GR in 3 groups of consecutive patients in order to determine the effect of the learning period and the experience on the technique and the outcome. One hundred and fifty patients (84 men and 66 women) with an average age of 52.2 years (18 to 78) were included. Surgery was indicated for failure or early relapse following the end of medical treatment. The preoperative work-up (endoscopy, barium meal or oesophageal pH monitoring) was governed by the clinical picture. The choice between TF and PF was based on the results of pH monitoring. Three groups of 50 patients around were chronologically defined. The parameters that were examined were: the operative technique; the conversion rate; the mortality and morbidity rate; the duration of surgery and hospitalization and the results at short and medium term follow-up. The three groups were comparable with respect to patient characteristics and the nature of their GERD. All patients had an endoscopy, 91% a barium meal, 77.5% underwent esophageal manometry and 67% pH monitoring. One hundred and thirty two patients had a TF and 18 had a PF. Rosetti's type TF became the reference procedure (80.3% in group III) and closure of the diaphragmatic crura was performed systematically in group III (100%). The duration of surgery was significantly reduced between group I and the two other groups (138, 100, 80 mn.). The rate of conversion, due to a variety of causes, decreased from 10.2% to 4% and then 0%. The average duration of hospitalization decreased from 5.8 to 4.2 days (p = 0.01). There was no mortality and the morbidity rate decreased from 14.3% to 4% and then 0%. There was 7 cases of relapse (4.6%), 5 in group 1 (10.2%) and 2 in group II (4%), with no cases in group III although the follow-up is shorter. There is an effect of the learning curve on the outcome of treatment for GR and this must be taken into account in the training of surgeons (training within experienced departments and "guidance" during their initial interventions) and also in publications in order to allow a more accurate comparison of the different treatments for GERD.
对于胃食管反流病（GERD），通过部分（PF）或全胃底折叠术（TF）进行腹腔镜治疗是在适当药物治疗失败后的当前手术治疗选择。胃底折叠术的总体结果包括初始学习期，在此期间并发症和失败率可能更高。本研究的目的是比较连续三组患者腹腔镜治疗GER的结果，以确定学习期和技术经验对治疗效果的影响。纳入了150例患者（84例男性和66例女性），平均年龄52.2岁（18至78岁）。手术适用于药物治疗结束后失败或早期复发的情况。术前检查（内镜检查、钡餐或食管pH监测）根据临床表现进行。TF和PF之间的选择基于pH监测结果。按时间顺序定义了三组，每组约50例患者。检查的参数包括：手术技术；中转率；死亡率和发病率；手术和住院时间以及短期和中期随访结果。三组在患者特征和GERD性质方面具有可比性。所有患者均进行了内镜检查，91%进行了钡餐检查，77.5%进行了食管测压，67%进行了pH监测。132例患者接受了TF，18例接受了PF。罗塞蒂式TF成为参考手术方式（第三组中占80.3%），第三组系统性地进行了膈脚闭合（100%）。第一组与其他两组相比，手术时间显著缩短（138、100、80分钟）。由于各种原因导致的中转率从10.2%降至4%，然后降至0%。平均住院时间从5.8天降至4.2天（p = 0.01）。无死亡病例，发病率从14.3%降至4%，然后降至0%。有7例复发（4.6%），第一组5例（10.2%），第二组2例（4%），第三组无复发病例，尽管随访时间较短。学习曲线对GER治疗效果有影响，这在外科医生培训（在有经验的科室培训以及初始手术时的“指导”）以及出版物中都必须予以考虑，以便更准确地比较GERD的不同治疗方法。
