Tosato F, Paltrinieri G, Monsellato I, Leonardo G, Martire I, Palombi L
Università degli Studi di Roma "La Sapienza", Policlinico Umberto I, Dipartimento di Chirurgia Generale e Day Surgery "F. Durante".
G Chir. 2008 Mar;29(3):102-5.
The aim of this study is to valuate the opportunity to associate both laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in patients with gallbladder cholelithiasis and gastro-oesophageal acid reflux (endoscopically and pHmetrically assessed), considerating that the gallbladder removal makes duodenal-gastric reflux worse.
From 2005 until 2007 we associated laparoscopic Nissen-Rossetti fundoplication and cholecystectomy in 10 patiens, who presented surgical indications for gallbladder cholelithiasis and gastro-oesophageal reflux. Clinical data, surgical procedures and post-operative complications were compared to our esperiency on the singular procedure (laparoscopic Nissen-Rossetti fundoplication and cholecystectomy). Results were valuated at 3, 6 and 12 months after surgical interventions by clinical and instrumental follow up (24-pH-metry and oesophagus-gastro-duodenoscopy).
The analysis of instrumental data of these associated procedures doesn't present significative differences between the singular surgical approach. In all the patients treated by combined procedure, the follow-up shows a normal pHmetric exam, a good control on the acid reflux by fundosplication, absence of distal oesophagitis and gastric reflux symptoms.
The association of laparoscopic Nissen-Rossetti fundoplication and laparoscopic cholecystectomy is indicated in patients who present both pathologies and needs to be considerating in relations to the good results and the low postoperatoric morbidity.
本研究的目的是评估在患有胆囊结石和胃食管酸反流(经内镜和pH值测定评估)的患者中联合进行腹腔镜Nissen-Rossetti胃底折叠术和胆囊切除术的机会,同时考虑到切除胆囊会使十二指肠-胃反流恶化。
从2005年到2007年,我们对10例患者联合进行了腹腔镜Nissen-Rossetti胃底折叠术和胆囊切除术,这些患者有胆囊结石和胃食管反流的手术指征。将临床数据、手术过程和术后并发症与我们在单一手术(腹腔镜Nissen-Rossetti胃底折叠术和胆囊切除术)中的经验进行比较。在手术干预后的3、6和12个月,通过临床和器械随访(24小时pH值测定和食管-胃-十二指肠镜检查)对结果进行评估。
对这些联合手术的器械数据分析显示,单一手术方法之间没有显著差异。在所有接受联合手术治疗的患者中,随访显示pH值测定检查正常,胃底折叠术对酸反流控制良好,无远端食管炎和胃反流症状。
对于同时患有这两种疾病的患者,腹腔镜Nissen-Rossetti胃底折叠术和腹腔镜胆囊切除术联合应用是可行的,鉴于其良好的效果和较低的术后发病率,应予以考虑。