TianJin Medical University, TianJin Mini-invasive Surgery Center, TianJin NanKai Hospital, TianJin, China.
Dis Esophagus. 2012 Feb;25(2):114-20. doi: 10.1111/j.1442-2050.2011.01235.x. Epub 2011 Aug 24.
Anterior partial fundoplication (AF) has been popularized by a lower risk of mechanical side effects. The question then emerges whether anterior partial wrap has a similar antireflux effect with Nissen fundoplication (NF). We therefore conducted a randomized study to compare the long-term outcome of anterior fundoplication with NF. One hundred patients who enrolled in the trial from May 2003 to March 2005 were randomized to laparoscopic AF or laparoscopic NF. Endoscopy, pH monitoring, manometry, a detailed questionnaire, and a visual analog symptom score were completed preoperative at 6, 12, 24, and 60 months after surgical procedures. The postoperative adverse effects such as dysphagia and flatulence were compared between the two groups. Revision surgery or maintenance proton pump inhibitor therapy was defined as failure. Fifty procedures were performed in each group. The outcome at 5 years follow-up was determined for 96 patients (96%; 49 patients in the AF group and 47 in the NF group). Three patients (3%) died of unrelated causes during follow-up, and one patient changed address. Both fundoplications were found to provide good control of reflux-related symptoms in most of the patients. For 96 patients followed up more than 5 years, gastroesophageal reflux symptoms were well controlled in 81 patients (84.38%); the mean DeMeester scores in the AF group decreased from 106.89 ± 14.12 to 12.67 ± 3.14 and in the NF group from 109.51 ± 17.98 to 10.81 ± 2.65, and the esophagitis was ameliorated visibly. Moreover, there were significantly fewer patients in the AF group who complained of flatulence. Compared with NF, anterior 180° partial fundoplication is an effective treatment of gastroesophageal reflux and associates with fewer postoperative adverse effects.
前侧部分胃底折叠术（AF）以机械性副作用风险较低而广受欢迎。那么，前侧部分包裹是否具有与尼森胃底折叠术（NF）相似的抗反流效果呢？因此，我们进行了一项随机研究，比较前侧胃底折叠术与 NF 的长期疗效。2003 年 5 月至 2005 年 3 月期间，共有 100 名患者参加了这项试验，他们被随机分为腹腔镜 AF 组或腹腔镜 NF 组。术前、术后 6、12、24 和 60 个月时，完成内镜、pH 监测、测压、详细问卷和视觉模拟症状评分。比较两组术后不良反应（如吞咽困难和呃逆）。将再次手术或维持质子泵抑制剂治疗定义为失败。每组进行 50 例手术。对 96 例患者（96%；AF 组 49 例，NF 组 47 例）进行了 5 年随访。随访期间，有 3 例（3%）患者因非相关原因死亡，1 例患者改变了地址。两种胃底折叠术都能为大多数患者提供良好的反流相关症状控制。在随访超过 5 年的 96 例患者中，81 例（84.38%）患者胃食管反流症状得到良好控制；AF 组的平均 DeMeester 评分从 106.89±14.12 降至 12.67±3.14，NF 组从 109.51±17.98 降至 10.81±2.65，食管炎明显改善。此外，AF 组中抱怨呃逆的患者明显减少。与 NF 相比，前 180°部分胃底折叠术是一种有效的胃食管反流治疗方法，且术后不良反应较少。
