腹腔镜 Nissen 和腹腔镜 Toupet 胃底折叠术治疗胃食管反流病的长期疗效：一项前瞻性、随机试验。
Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial.
机构信息
Department of Surgery, J45 OMB, Health Sciences Faculty, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa.
出版信息
Surg Endosc. 2010 Apr;24(4):924-32. doi: 10.1007/s00464-009-0700-3. Epub 2009 Sep 30.
BACKGROUND
A prospective, randomized trial was performed to evaluate the long-term outcome and patient satisfaction of laparoscopic complete 360 degrees fundoplication compared with partial posterior 270 degrees fundoplication. Partial fundoplication is purported to have fewer side effects with a higher failure rate in controlling gastroesophageal reflux disease (GERD), while complete fundoplication is thought to result in more dysphagia and gas-related symptoms.
METHODS
Patients were randomized to either laparoscopic Nissen (LN) or laparoscopic Toupet (LT) fundoplication. Esophageal manometry, 24-h pH studies, a detailed questionnaire, and a visual analog symptom (VAS) score were completed before and after surgery. A final global outcome questionnaire was performed. Failure was defined as recurrent GERD requiring revision surgery, maintenance proton pump inhibitor (PPI) therapy, or surgery for postoperative dysphagia.
RESULTS
One hundred patients were randomized to LN (50) or LT (50). There were no differences between LN and LT with respect to postoperative symptoms and physiological variables except a higher wrap pressure in the LN group (15.2 vs. 12.0 mmHg). Dysmotility improved in 8/14 (57%) and 6/11 (54%) patients in the LN group and the LT group, respectively, after surgery. There was no correlation between dysmotility and dysphagia both pre- and post surgery in the two groups. Recurrent symptoms of GERD occurred in 8/47 (17.0%) and 8/48 (16.6%) in the LN group and the LT group, respectively. Outcome of patients with dysmotility was similar to those with normal motility in both groups. At final follow-up (59.76 + or - 24.23 months), in the LN group, 33/37 (89.1%) would recommend surgery to others, 32/37 (86.4%) would have repeat surgery, and 34/37 (91.8%) felt they were better off than before surgery. The corresponding numbers for the LT group (follow-up = 55.18 + or - 25.97 months) were 35/36 (97.2%), 30/36 (83.3%), and 33/36 (91.6%).
CONCLUSION
LN and LT are equally effective in restoring the lower esophageal sphincter function and provide similar long-term control of GERD with no difference in dysphagia. Esophageal dysmotility had no influence on the outcome of either operation.
背景
一项前瞻性、随机试验评估了腹腔镜全 360 度胃底折叠术与部分后 270 度胃底折叠术的长期结果和患者满意度。部分胃底折叠术被认为具有较少的副作用，但在控制胃食管反流病（GERD）方面失败率较高，而全胃底折叠术则被认为会导致更多的吞咽困难和与气体相关的症状。
方法
患者被随机分为腹腔镜 Nissen（LN）或腹腔镜 Toupet（LT）胃底折叠术。在手术前后完成食管测压、24 小时 pH 研究、详细问卷和视觉模拟症状（VAS）评分。最后进行了全球结局问卷调查。失败定义为复发性 GERD 需要再次手术、维持质子泵抑制剂（PPI）治疗或因术后吞咽困难而手术。
结果
100 例患者被随机分为 LN（50 例）或 LT（50 例）。LN 组和 LT 组在术后症状和生理变量方面无差异，除 LN 组包裹压力较高（15.2 对 12.0mmHg）外。术后，LN 组和 LT 组分别有 8/14（57%）和 6/11（54%）患者的动力障碍得到改善。两组患者术前和术后的动力障碍与吞咽困难均无相关性。LN 组和 LT 组分别有 8/47（17.0%）和 8/48（16.6%）的患者出现复发性 GERD 症状。两组动力障碍患者的结局与正常动力障碍患者相似。在最后一次随访（59.76+或-24.23 个月）时，LN 组 37 例中有 33 例（89.1%）会向他人推荐手术，37 例中有 32 例（86.4%）会再次手术，37 例中有 34 例（91.8%）感觉比术前更好。LT 组（随访=55.18+或-25.97 个月）的相应数字分别为 36 例中的 35 例（97.2%）、36 例中的 30 例（83.3%）和 36 例中的 33 例（91.6%）。
结论
LN 和 LT 在恢复食管下括约肌功能方面同样有效，对 GERD 的长期控制效果相似，吞咽困难无差异。食管动力障碍对两种手术的结果均无影响。
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