Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ann Surg. 2011 May;253(5):875-8. doi: 10.1097/SLA.0b013e3182171c48.
We lack long-term data (>10 years) on the efficacy of antireflux surgery when evaluated within the framework of randomized clinical trials Hereby we report the outcome of a randomized trial comparing open total (I) and a Toupet posterior partial fundoplication (II) performed between 1983 and 1991.
One hundred and thirty-seven patients with gastroesophageal reflux disease and were enrolled into the study. The mean follow up has now reached 18 years. During these years 26% had died and 16% were unable to trace for follow up. Symptom outcomes were assessed by the use of validated self-reporting questionnaires.
Long-term control of heartburn and acid regurgitation (reported as no or mild symptoms) were reported by 80% and 82% after a total fundoplication (I) and corresponding figures were 87% and 90% after a partial posterior fundoplication (II), respectively (n.s.).The dysphagia scores were low 4.6 ± 1.3 (SEM) in group I and 3.3 ± 0.9 (SEM) in group II (n.s). The point prevalences of rectal flatulence and gas distension related complaints were of similar magnitude in the 2 groups. Twenty-three percentage of the patients in the total fundoplication group noted some ability to vomit compared with 31% in the partial posterior fundoplication group.
Both a total and a partial posterior fundoplication maintain a high level of reflux control after 2 decades of follow up. The previously reported differences in mechanical side effects, in favor of the partial wrap, seemed to disappear over time.
我们缺乏抗反流手术的长期数据（>10 年），这些数据是在随机临床试验框架内评估的。在此，我们报告了一项比较 1983 年至 1991 年间进行的开放式全胃（I）和 Toupet 后部分胃底折叠术（II）的随机试验结果。
137 例胃食管反流病患者被纳入研究。目前的平均随访时间已达到 18 年。在此期间，26%的患者死亡，16%的患者无法追踪随访。通过使用经过验证的自我报告问卷评估症状结果。
全胃底折叠术（I）后，80%和 82%的患者报告长期控制烧心和胃酸反流（报告为无或轻度症状），相应的数字分别为 87%和 90%在部分后胃底折叠术（II）后（无统计学差异）。吞咽困难评分较低，I 组为 4.6±1.3（SEM），II 组为 3.3±0.9（SEM）（无统计学差异）。两组患者直肠气胀和腹胀相关投诉的点患病率相似。与部分后胃底折叠术组的 31%相比，全胃底折叠术组有 23%的患者有一定的呕吐能力。
在 20 年的随访后，全胃底折叠术和部分后胃底折叠术都能保持高水平的反流控制。先前报道的机械副作用差异，有利于部分包裹，随着时间的推移似乎消失了。
