Liang Wei-Tao, Yan Chao, Wang Zhong-Gao, Wu Ji-Min, Hu Zhi-Wei, Zhan Xiu-Lan, Wang Feng, Ma Song-Song, Chen Mei-Ping
1 Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University , Beijing, China .
2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China .
J Laparoendosc Adv Surg Tech A. 2015 Aug;25(8):657-61. doi: 10.1089/lap.2015.0188.
Although the minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage gastroesophageal reflux disease (GERD), the benefits of this procedure have to be further evaluated in clinical settings. This prospective observational study assessed the short-term and midterm outcomes associated with laparoscopic Toupet fundoplication (LTF) and the Stretta procedure.
From January 2011 to January 2012, we allocated 80 patients to LTF and 85 to the Stretta procedure. Primary outcome measures, including symptom scores of heartburn, regurgitation, chest pain, belching, hiccup, cough, and asthma, as well as proton pump inhibitor (PPI) use, were analyzed at midterm follow-up (1-3 years).
Of the 165 patients, 125 patients following LTF (n=65) or the Stretta procedure (n=60) completed the designated 3-year follow-up and were included in the final analysis. At the end of the 3-year follow-up, the symptom scores were all significantly decreased compared with the corresponding values before the two procedures in both groups (P<.05). After LTF and the Stretta procedure, 47/65 (72.3%) and 41/60 (68.3%) patients, respectively, achieved complete PPI therapy independence (72.3% versus 68.3%, P=.627). Comparing with LTF, however, the Stretta procedure had less effect on improving typical symptoms of heartburn, regurgitation, and chest pain and reducing the rate of re-operation (11.8% versus 0%, P=.006).
LTF and the Stretta procedure were equally effective in controlling GERD symptoms and reducing PPI use. However, LTF can achieve more improvement on typical symptoms and has a lower rate of re-operation.
尽管微创内镜下Stretta手术越来越多地被用作治疗胃食管反流病（GERD）的替代策略，但该手术的益处仍需在临床环境中进一步评估。这项前瞻性观察性研究评估了腹腔镜Toupet胃底折叠术（LTF）和Stretta手术的短期和中期结果。
2011年1月至2012年1月，我们将80例患者分配至LTF组，85例患者分配至Stretta手术组。在中期随访（1 - 3年）时分析主要结局指标，包括烧心、反流、胸痛、嗳气、打嗝、咳嗽和哮喘的症状评分，以及质子泵抑制剂（PPI）的使用情况。
165例患者中，125例接受LTF（n = 65）或Stretta手术（n = 60）的患者完成了指定的3年随访并纳入最终分析。在3年随访结束时，两组患者的症状评分与两种手术前的相应值相比均显著降低（P <.05）。LTF和Stretta手术后，分别有47/65（72.3%）和41/60（68.3%）的患者实现了完全停用PPI治疗（72.3%对68.3%，P =.627）。然而，与LTF相比，Stretta手术在改善烧心、反流和胸痛等典型症状以及降低再次手术率方面效果较差（11.8%对0%，P =.006）。
LTF和Stretta手术在控制GERD症状和减少PPI使用方面同样有效。然而，LTF在改善典型症状方面效果更佳，且再次手术率更低。
