Department of Surgery, Duke University, Durham, NC, USA.
Surg Endosc. 2013 Apr;27(4):1334-8. doi: 10.1007/s00464-012-2609-5. Epub 2012 Oct 17.
Nissen-Collis gastroplasty (NCG) is an effective treatment for short esophagus, but it sometimes is associated with abnormal postoperative esophageal acid exposure. This study was designed to test the hypothesis that NCG prevents gastric reflux and that pathologic distal esophagus acid exposure is due to prolonged acid clearance in the "neoesophagus."
The study enrolled 11 normal healthy subjects (ten patients status post--laparoscopic Nissen fundoplication and nine patients status post-NCG). All the participants were age and gender matched, and all were studied via manometry, acid-clearance test, and 24-h pH analysis. The clearance test was performed according to an established protocol. A 15-ml acid bolus (pH 1.2) was rapidly infused (×4) using a nasogastric tube 15 cm proximal to the lower esophageal sphincter, followed by dry swallows every 30 s until the esophageal pH rose above 4.
All the subjects had normal esophageal peristalsis and distal amplitudes. The acid-clearance time was significantly higher with NCG (P < 0.001 vs Nissen and normal subjects). Pathologic esophageal acid exposure occurred in one of ten Nissen patients (10 %) and in two of nine NCG patients (22 %) (nonsignificant difference [NS]). The median distal esophageal acid exposure time during the 24-h pH study was similar in the two groups (NCG, 1.2 %; Nissen, 2.5 %; NS).
The findings showed that NCG is an adequate antireflux procedure but that it is characterized by a delayed esophageal acid clearance.
Nissen-Collis 胃底折叠术（NCG）是治疗短食管的有效方法，但有时与异常术后食管酸暴露有关。本研究旨在验证假设，即 NCG 可预防胃反流，而病理性远端食管酸暴露是由于“新食管”中酸清除时间延长所致。
本研究纳入了 11 名正常健康受试者（10 名腹腔镜 Nissen 胃底折叠术后患者和 9 名 NCG 术后患者）。所有受试者的年龄和性别相匹配，均通过测压、酸清除试验和 24 小时 pH 分析进行研究。清除试验按照既定方案进行。使用距食管下括约肌近端 15 厘米的鼻胃管快速输注 15 毫升 pH 值为 1.2 的酸液（×4），随后每隔 30 秒吞咽干口水，直到食管 pH 值升至 4 以上。
所有受试者均具有正常的食管蠕动和远端幅度。NCG 的酸清除时间明显较长（P<0.001 与 Nissen 和正常组相比）。在 10 名 Nissen 患者中有 1 名（10%）和在 9 名 NCG 患者中有 2 名（22%）发生病理性食管酸暴露（无显著差异[NS]）。在 24 小时 pH 研究中，两组的远端食管酸暴露时间中位数相似（NCG，1.2%；Nissen，2.5%；NS）。
研究结果表明，NCG 是一种充分的抗反流手术，但它的特点是食管酸清除时间延长。
