Heloury Y, Savigny B, Baron M, Plattner V, Borde L, Le Neel J C
Service de Chirurgie Infantile, Hôtel Dieu, Nantes.
J Chir (Paris). 1991 Dec;128(12):541-3.
Nissen's fundal plication is acknowledged as the most effective procedure to suppress gastroesophageal reflux. It entails some morbidity (dysphagia, gas bloat syndrome), in which obstruction is the least frequently evoked but most severe risk. We report about 6 cases (4 children and 2 adults). The 4 children had been operated 3 times during the first few months of life, and their reflux was secondary to the cure of atresia of the esophagus in 2 cases, and caused severe apneas in 1 case, a former premature infant. In three cases, the obstruction was complicated within a few hours by intestinal ischemia causing death. In one case, the emergent insertion of a gastric tube allowed the decompression of the digestive tract and second surgery; the obstruction recurred 2 months later, with no postoperative complications. Two adults (aged 64 and 66) presented with gastric perforation 7 days and 9 months after fundal pliction; one of them died. These cases show how serious these obstructions are (4 deaths/6 cases). The emergent measure in such cases consists of inserting a gastric tube, although which may be impossible (1 case). The patients and their parents must be informed of this risk of complication and of its expressions. Prevention is based on a strictly submesocolic surgical approach, without any exposure of the small bowel.
尼森胃底折叠术被公认为抑制胃食管反流最有效的手术方法。它会带来一些并发症（吞咽困难、气胀综合征），其中梗阻是最不常引发但最严重的风险。我们报告6例病例（4名儿童和2名成人）。4名儿童在出生后的头几个月内接受了3次手术，其中2例反流继发于食管闭锁的治愈，1例曾是早产儿，反流导致严重呼吸暂停。3例中，梗阻在数小时内并发肠缺血导致死亡。1例中，紧急插入胃管使消化道减压并进行了二次手术；梗阻在2个月后复发，无术后并发症。2名成人（64岁和66岁）在胃底折叠术后7天和9个月出现胃穿孔；其中1例死亡。这些病例显示了这些梗阻有多严重（6例中有4例死亡）。此类病例的紧急措施包括插入胃管，尽管这可能无法实施（1例）。必须告知患者及其父母这种并发症的风险及其表现。预防基于严格的结肠系膜下手术入路，不暴露小肠。
