腹腔镜抗反流手术的十年疗效

Ten-year outcome of laparoscopic antireflux surgery.

作者信息

Fein M, Bueter M, Thalheimer A, Pachmayr V, Heimbucher J, Freys S M, Fuchs K-H

机构信息

Chirurgische Klinik und Poliklinik I, Klinikum der Universität Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.

出版信息

J Gastrointest Surg. 2008 Nov;12(11):1893-9. doi: 10.1007/s11605-008-0659-8. Epub 2008 Sep 3.

DOI:10.1007/s11605-008-0659-8

PMID:18766417

Abstract

BACKGROUND

Reflux recurrence is the most common long-term complication of fundoplication. Its frequency was independent from the type of fundoplication in randomized studies. Results for different techniques of laparoscopic antireflux surgery were retrospectively evaluated after 10 years.

METHODS

From 1992 to 1997, 120 patients had primary laparoscopic fundoplication with a "tailored approach" (type of wrap chosen according to esophageal peristalsis): 88 received a Nissen, 22 an anterior, and 10 a Toupet fundoplication. Follow-up of 87% of the patients included disease-related questions and the gastrointestinal quality-of-life index (GIQLI).

RESULTS

Of the patients, 89% would select surgery again. Heartburn was reported by 30% of the patients. Regurgitations were noted from 15% of patients after a Nissen, 44% after anterior fundoplication, and 10% after a Toupet (p = 0.04). Twenty-eight percent were on acid-suppressive drugs again. Following Nissen fundoplication, proton pump inhibitors were less frequently used (p = 0.01) and on postoperative pH-metry reflux recurrence rate was lower (p = 0.04). The GIQLI was 110 +/- 24 without significant differences for the type of fundoplication.

DISCUSSION

Ten years after laparoscopic fundoplication, overall outcome is good. A quarter of the patients are on acid-suppressive drugs. Nissen fundoplication appears to control reflux better than a partial fundoplication.

摘要

背景

反流复发是胃底折叠术最常见的长期并发症。在随机研究中，其发生率与胃底折叠术的类型无关。对不同腹腔镜抗反流手术技术的结果进行了10年的回顾性评估。

方法

1992年至1997年，120例患者接受了“量身定制法”的初次腹腔镜胃底折叠术（根据食管蠕动选择包绕类型）：88例接受了nissen术，22例接受了前胃底折叠术，10例接受了Toupet胃底折叠术。87%的患者随访包括与疾病相关的问题和胃肠道生活质量指数（GIQLI）。

结果

89%的患者会再次选择手术。30%的患者报告有烧心症状。nissen术后15%的患者出现反流，前胃底折叠术后44%，Toupet术后10%（p = 0.04）。28%的患者再次使用抑酸药物。nissen胃底折叠术后，质子泵抑制剂的使用频率较低（p = 0.01），术后pH值测定反流复发率较低（p = 0.04）。GIQLI为110±24，胃底折叠术类型之间无显著差异。