Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
Department of Upper Gastrointestinal Surgery, Birmingham Heartland Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
Int J Surg. 2015 Jan;13:257-260. doi: 10.1016/j.ijsu.2014.12.013. Epub 2014 Dec 19.
Laparoscopic partial fundoplication for gastro-oesophageal reflux disease (GORD) is reported to have fewer side effects when compared to Nissen fundoplication, but doubts remain over its long term durability in controlling reflux. The aim of this study was to assess outcome of symptoms for all patients presenting with GORD undergoing routine laparoscopic subtotal Lind fundoplication.
MATERIALS & METHODS: All patients undergoing laparoscopic fundoplication between August, 1999 and November, 2007 performed by a single surgeon were included in the study. The anti-reflux procedure studied was laparoscopic Lind (300°) fundoplication with crural repair in all cases. Patients completed pre and post-operative questionnaires containing validated scoring systems for heartburn, gas bloat, dysphagia and overall patient satisfaction.
Over the 100-month period, 320 consecutive patients underwent laparoscopic subtotal Lind fundoplication. Of these, 256 (80%) replied to the questionnaire at a mean of 31 months (range 3-96 months) following surgery. 91.4% of respondents had an improvement in heartburn symptom score with a significant reduction in score from 7.74 preoperatively to 1.25 postoperatively (p<0.001). There was also a significant reduction of mean modified Visick score for reflux control (heartburn and regurgitation) from 3.49 preoperatively to 1.48 after surgery (p<0.001). In total, 22 patients developed recurrent reflux symptoms with half of these reporting their recurrence within two years following surgery. Because of this all were tested with post-operative pH testing, yet only one had a 24-h pH time outside the normal range. Overall patient satisfaction was high with a visual analogue score of 9 and 88% of the patients claimed they would have the operation again.
Laparoscopic Lind fundoplication demonstrates excellent reflux control when performed routinely for all patients presenting with GORD. This technique is both durable and efficacious in controlling reflux symptoms.
与 Nissen 胃底折叠术相比，腹腔镜胃食管反流病（GORD）部分胃底折叠术的副作用较少，但对于其长期控制反流的耐久性仍存在疑问。本研究旨在评估所有接受常规腹腔镜次全 Lind 胃底折叠术治疗 GORD 的患者的症状结果。
研究纳入了 1999 年 8 月至 2007 年 11 月期间由同一位外科医生进行的腹腔镜胃底折叠术患者。研究中使用的抗反流手术是腹腔镜 Lind（300°）胃底折叠术，所有病例均行胃底折叠术。患者在术前和术后完成包含烧心、气体膨满、吞咽困难和总体患者满意度等有效评分系统的问卷。
在 100 个月的时间内，320 例连续患者接受了腹腔镜次全 Lind 胃底折叠术。其中，256 例（80%）在术后 31 个月（3-96 个月）回复了问卷。91.4%的患者报告烧心症状评分有所改善，术后评分从术前的 7.74 分显著降低至 1.25 分（p<0.001）。反流控制（烧心和反流）的改良 Visick 评分也显著降低，从术前的 3.49 分降至术后的 1.48 分（p<0.001）。共有 22 例患者出现复发性反流症状，其中一半患者在术后两年内报告复发。因此，所有患者均接受了术后 pH 检测，但仅有 1 例患者 24 小时 pH 值超出正常范围。总体患者满意度较高，视觉模拟评分（VAS）为 9 分，88%的患者表示他们会再次接受手术。
腹腔镜 Lind 胃底折叠术对于所有接受 GORD 治疗的患者常规进行，可有效控制反流。该技术在控制反流症状方面既持久又有效。
