Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
Surg Endosc. 2011 Oct;25(10):3235-44. doi: 10.1007/s00464-011-1699-9. Epub 2011 May 14.
Gastroesophageal reflux disease (GERD) is among the most common dysfunctions of the upper gastrointestinal tract. It interferes with quality of life and is a risk factor for the development of adenocarcinoma in the lower esophagus. Laparoscopic fundoplication is an effective treatment of GERD, but the physiologic mechanisms of the different available procedures had not been investigated to date.
In this study, 28 German Landrace pigs underwent baseline manometry and 24-h pH monitoring followed by myotomy to induce reflux esophagitis. After new-onset reflux was proved, the pigs were randomized to groups based on four treatments: total fundoplication, anterior hemifundoplication, posterior hemifundoplication, and control. On days 10 and 60 after the intervention, the effectiveness of the different fundoplication modifications was compared with that of the control subjects by 24-h pH monitoring manometry. Finally, the pigs were killed, after which the minimum volume and pressure required to breach the gastroesophageal junction were recorded.
After myotomy, a significant increase in the reflux could be confirmed. The findings after fundoplication showed a significant decrease in the fraction of time that the pH fell below four and an increase in the vector volume compared with the measurement after myotomy. Total fundoplication and posterior hemifundoplication were highly effective, whereas measurements after anterior fundoplication still showed increased fraction times. Pharmacologic stimulation with pentagastrin showed an increase in the vector volume of the esophageal sphincter.
Total fundoplication and posterior hemifundoplication are potent operations for the treatment of GERD. Anterior hemifundoplication reduces the reflux as well, but the effects are significantly less than with total and posterior fundoplication. Pharmacologic stimulation showed excellent results after posterior hemifundoplication, and a tendency to overcorrection was shown after total fundoplication.
胃食管反流病（GERD）是上消化道最常见的功能障碍之一。它会影响生活质量，并且是食管下段腺癌发生的一个危险因素。腹腔镜胃底折叠术是 GERD 的有效治疗方法，但迄今为止尚未研究过不同术式的生理机制。
本研究中，28 头德国长白猪进行了基线测压和 24 小时 pH 监测，然后进行肌切开术以诱导反流性食管炎。在新出现反流后，猪被随机分为四组：全胃底折叠术、前半胃底折叠术、后半胃底折叠术和对照组。在干预后第 10 天和第 60 天，通过 24 小时 pH 监测测压比较不同胃底折叠术式的治疗效果。最后，处死猪，记录胃食管交界处突破所需的最小容积和压力。
肌切开术后，可确认反流明显增加。胃底折叠术后的发现显示，与肌切开术后相比，pH 值降至 4 以下的时间分数显著减少，矢量容积增加。全胃底折叠术和后半胃底折叠术非常有效，而前胃底折叠术的测量结果仍显示时间分数增加。五肽胃泌素的药物刺激显示食管括约肌的矢量容积增加。
全胃底折叠术和后半胃底折叠术是治疗 GERD 的有效手术。前半胃底折叠术也可减少反流，但效果明显低于全胃底和后半胃底折叠术。药物刺激在后半胃底折叠术后显示出良好的效果，而全胃底折叠术后显示出过度矫正的趋势。
