Popiela T, Kawiorski W, Richter P, Legutko J, Kibil W
Department of General and GI Surgery, Jagiellonian University, Kraków, Poland.
Acta Chir Belg. 2005 May-Jun;105(3):275-82. doi: 10.1080/00015458.2005.11679716.
Gastroesophageal Reflux Disease (GERD) is a common non-malignant gastrointestinal disease. The introduction of minimally invasive surgical techniques and the high costs of pharmacotherapy increased the number of patients subjected to surgical antireflux treatment. Furthermore, the use of advanced technique of manometry--including intraoperative video-assisted continuous pressure monitoring--made possible complicated but objective analysis of the pressure profile in the newly created area of gastroesophageal junction.
The current study was conducted in 159 patients. A group consisted of 93 men and 66 women, mean age of 38 years (range 18-72), subjected to antireflux surgery with continuous intraoperative video-assisted manometry of pressure in the newly created gastroesophageal junction (fundoplication wrap). Surgical procedure was individually tailored in each case depending on the motility parameters and GERD etiology. Eighty seven patients (55%) underwent 360 degrees Nissen fundoplication, 17 "floppy" Nissen procedure (11%), 22 Dor hemifundoplication (14%), and 33 Toupet hemifundoplication (21%).
Out of the 159 patients subjected to antireflux procedures only 8 (5.0%) developed dysphagia, and 12 (7.5%) recurrent reflux disease. Recurrent reflux symptoms were most frequently caused by the dislocation of the fundoplication wrap. Dysphagia occurred in patients with too tight fundoplication wrap or because of its dislocation with subsequent rotation and angulation that impaired food passage. In some patients objective causes of dysphagia have not been found. In these patients no abnormalities were detected by the postoperative visualising examinations, and mean pressure in the fundoplication wrap did not exceed critical values. In these cases, dysphagia was caused probably by impaired gastric motility.
胃食管反流病（GERD）是一种常见的非恶性胃肠道疾病。微创外科技术的引入以及药物治疗的高昂费用增加了接受手术抗反流治疗的患者数量。此外，测压先进技术的应用——包括术中视频辅助连续压力监测——使得对新形成的胃食管交界处区域的压力分布进行复杂但客观的分析成为可能。
本研究对159例患者进行。该组包括93名男性和66名女性，平均年龄38岁（范围18 - 72岁），接受了抗反流手术，并在新形成的胃食管交界处（胃底折叠包裹处）进行术中连续视频辅助压力测压。手术程序根据每个病例的动力参数和GERD病因进行个体化定制。87例患者（55%）接受了360度nissen胃底折叠术，17例接受“松弛型”nissen手术（11%），22例接受Dor半胃底折叠术（14%），33例接受Toupet半胃底折叠术（21%）。
在接受抗反流手术的159例患者中，仅8例（5.0%）出现吞咽困难，12例（7.5%）出现复发性反流病。复发性反流症状最常见的原因是胃底折叠包裹处的移位。吞咽困难发生在胃底折叠包裹过紧的患者中，或者是由于其移位并随后旋转和成角，从而阻碍了食物通过。在一些患者中，未发现吞咽困难的客观原因。在这些患者中，术后影像学检查未发现异常，胃底折叠包裹处的平均压力未超过临界值。在这些情况下，吞咽困难可能是由胃动力受损引起的。
