小儿外科中的胃底折叠术：德国40家机构的一项调查。

Schmidt A I, Glüer S, Ure B M

Department of Paediatric Surgery, Hannover Medical School, Hannover, Germany.

Eur J Pediatr Surg. 2005 Dec;15(6):404-8. doi: 10.1055/s-2005-872948.

BACKGROUND

There is no generally accepted standard surgical approach to gastrooesophageal reflux disease (GERD) at present. However, laparoscopic fundoplication has been advocated to be the procedure of choice for gastrooesophageal reflux disease in children. We aimed to assess the standards of the diagnostic workup and operative techniques in paediatric surgical institutions in Germany.

MATERIAL AND METHODS

A questionnaire including 14 items was sent to all 71 departments of paediatric surgery in Germany. Forty (56 %) took part in the survey. Concepts of routine diagnostic workup, operative techniques, number of procedures, and conversions were assessed.

RESULTS

The average annual frequency of fundoplications was less than 20 in 36 units (90 %). Experience with laparoscopic fundoplication was present in 24 institutions (60 %). In 19 out of these (79 %) fewer than 50 laparoscopic fundoplications had been performed altogether up to the time of the survey. Out of 584 fundoplications performed in the year 2002, 184 (32 %) had been done laparoscopically. The ratio of conventional versus laparoscopic fundoplication was 170/130 (57/43 %) in academic, and 226/54 (81/19 %) in non-academic departments. The preferred technique of fundoplication, irrespective of the approach, was the Nissen wrap in 28 (70 %) of the departments. The number of paediatric surgeons performing laparoscopic fundoplication was 1 - 2 in 16 institutions (67 %), 3 or 4 in 6 (25 %), and 5 in 2 (8 %) departments. The conversion rate was reported to be less than 5 % in 15 departments (63 %), and 5 - 10 % in 3 (13 %).

CONCLUSION

The laparoscopic approach for surgical repair of GERD in children is not yet generally accepted in Germany. In most departments, training remains problematic due to low numbers of procedures. However, the feasibility of laparoscopic fundoplication in Germany is excellent, with a low rate of conversions.

背景

目前尚无普遍接受的治疗胃食管反流病（GERD）的标准手术方法。然而，腹腔镜胃底折叠术已被提倡作为儿童胃食管反流病的首选术式。我们旨在评估德国儿科外科机构的诊断检查和手术技术标准。

材料与方法

向德国所有71个小儿外科科室发送了一份包含14项内容的问卷。40个科室（56%）参与了调查。对常规诊断检查的概念、手术技术、手术例数和中转情况进行了评估。

结果

36个科室（90%）的胃底折叠术年均例数少于20例。24个机构（60%）有腹腔镜胃底折叠术经验。在这些机构中的19个（79%），截至调查时，总共进行的腹腔镜胃底折叠术少于50例。在2002年进行的584例胃底折叠术中，184例（32%）是通过腹腔镜完成的。在学术科室中，传统胃底折叠术与腹腔镜胃底折叠术的比例为170/130（57/43%），在非学术科室中为226/54（81/19%）。无论采用何种方法，28个科室（70%）首选的胃底折叠术式是nissen折叠术。16个机构（67%）进行腹腔镜胃底折叠术的小儿外科医生人数为1 - 2名，6个机构（25%）为3或4名，2个科室（8%）为5名。15个科室（63%）报告中转率低于5%，3个科室（13%）为5 - 10%。