Nagpal Anish P, Soni Harshad, Haribhakti Sanjiv P
Department of Surgical Gastroenterolgogy and Advanced Laparoscopic Surgery, Haribhakti Surgical Hospital, Ahmedabad, Gujarat, India.
J Minim Access Surg. 2010 Apr;6(2):42-5. doi: 10.4103/0972-9941.65163.
To evaluate retrospectively the outcome of laparoscopic fundoplication in a cohort of patients with typical symptoms of gastroesophageal reflux disease (GERD).
Forty-two patients with typical symptoms of GERD, who were operated for laparoscopic Nissen's fundoplication from March 2001 to August 2008, were studied. The study was limited to patients with positive findings on upper gastrointestinal (GI) endoscopy done by us and "typical" symptoms (heartburn, regurgitation, and dysphagia) of GERD. Laparoscopic Nissen's fundoplication was performed when clinical assessment suggested adequate oesophageal motility and length. Only one patient who had negative endoscopic findings underwent a 24-h pH monitoring before surgery. Outcome measures included assessment of the relief of the primary symptom responsible for surgery in the early postoperative period; the patient's evaluation of outcome, and quality of life after surgery.
Relief of the primary symptom responsible for surgery was achieved in 95.24% of patients at a mean follow-up of 28 months. Thirty-five patients were asymptomatic, two had minor gastrointestinal symptoms not requiring medical therapy, three patients had gastrointestinal symptoms requiring medical therapy/Proton Pump Inhibitors (PPI) and in two patients the symptoms worsened after surgery. There were no deaths. Clinically significant complications occurred in six patients. Median hospital stay was 3 days, decreasing from 6 days in the first 10 patients to 3 days in the last 10 patients.
Laparoscopic Nissen's fundoplication is the choice of operation for clinically symptomatic GERD patients.
回顾性评估一组有典型胃食管反流病（GERD）症状患者行腹腔镜胃底折叠术的疗效。
研究对象为2001年3月至2008年8月间因腹腔镜尼氏胃底折叠术而接受手术的42例有典型GERD症状的患者。本研究仅限于经我们进行的上消化道（GI）内镜检查结果阳性且有GERD“典型”症状（烧心、反流和吞咽困难）的患者。当临床评估提示食管动力和长度适宜时，行腹腔镜尼氏胃底折叠术。只有1例内镜检查结果阴性的患者在手术前行24小时pH监测。观察指标包括术后早期对导致手术的主要症状缓解情况的评估；患者对手术疗效及术后生活质量的评价。
平均随访28个月时，95.24%的患者导致手术的主要症状得到缓解。35例患者无症状，2例有轻微胃肠道症状但无需药物治疗，3例患者有需要药物治疗/质子泵抑制剂（PPI）的胃肠道症状，2例患者术后症状加重。无死亡病例。6例患者发生了具有临床意义的并发症。中位住院时间为3天，从前10例患者的6天降至最后10例患者的3天。
腹腔镜尼氏胃底折叠术是有临床症状的GERD患者的手术选择。
