腹腔镜补片增强食管裂孔成形术作为一种不进行胃底折叠术治疗胃食管反流的方法：306例连续患者的单中心经验
Laparoscopic mesh-augmented hiatoplasty as a method to treat gastroesophageal reflux without fundoplication: single-center experience with 306 consecutive patients.
作者信息
Müller-Stich Beat P, Köninger Jörg, Müller-Stich Bettina H, Schäfer Fritz, Warschkow René, Mehrabi Arianeb, Gutt Carsten N
机构信息
Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany.
出版信息
Am J Surg. 2009 Jul;198(1):17-24. doi: 10.1016/j.amjsurg.2008.07.050. Epub 2009 Jan 29.
BACKGROUND
Laparoscopic fundoplication represents the surgical standard treatment of gastroesophageal reflux disease. However, because of persisting side effects the method is not without controversy. Laparoscopic mesh-augmented hiatoplasty might be an alternative.
METHODS
In 306 consecutive patients the perioperative course and symptomatic outcome was analyzed after a mean follow-up period of 52 months.
RESULTS
The mean DeMeester symptom score decreased from 5.3 to 2.0 (P < .001). Acid-suppressive therapy on a regular basis was discontinued in 79% of patients. The gas bloating value decreased from .7 to .5 (P = .031), and the dysphagia value increased from .5 to .9 (P < .001). Belching and vomiting were possible in 93% and 88% of patients, respectively. Mesh-related complications with the need for reoperation occurred in 1% of patients.
CONCLUSIONS
Laparoscopic mesh-augmented hiatoplasty is safe and does have an antireflux effect even without fundoplication. Side effects seem to be reasonable.
背景
腹腔镜胃底折叠术是胃食管反流病的外科标准治疗方法。然而，由于持续存在的副作用，该方法并非毫无争议。腹腔镜网状物增强裂孔成形术可能是一种替代方法。
方法
对306例连续患者进行分析，平均随访期为52个月，观察围手术期过程和症状结果。
结果
平均DeMeester症状评分从5.3降至2.0（P <.001）。79%的患者停止了常规抑酸治疗。胃胀值从0.7降至0.5（P = 0.031），吞咽困难值从0.5升至0.9（P <.001）。分别有93%和88%的患者出现嗳气和呕吐。1%的患者发生与网状物相关的并发症且需要再次手术。
结论
腹腔镜网状物增强裂孔成形术即使不进行胃底折叠术也是安全的，且确实具有抗反流作用。副作用似乎是合理的。
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