Hinder R A, Stein H J, Bremner C G, DeMeester T R
Department of Surgery, Creighton University Medical School, Omaha, Nebraska.
Ann Surg. 1989 Oct;210(4):458-64; discussion 464-5. doi: 10.1097/00000658-198910000-00006.
Delayed gastric emptying in patients with gastroesophageal reflux disease may be due to an incompetent distal esophageal sphincter and/or a gastric abnormality. To determine the influence of the Nissen fundoplication on gastric emptying we studied the rate of gastric emptying before and after operation in 25 patients with proved gastroesophageal reflux disease. Nine patients had no gastric pathology, 9 had gastric acid hypersecretion, 5 had gastritis, and 2 had evidence of significant duodenogastric reflux. All were treated by Nissen fundoplication. Those with gastric acid hypersecretion also had a proximal gastric vagotomy (PGV) and the two patients with pathologic duodenogastric reflux were treated by a bile diversion procedure. We found that in gastroesophageal reflux disease with associated gastric pathology there was a higher prevalence of delayed gastric emptying before operation than in patients without gastric pathology. Nissen fundoplication was associated with speeding of gastric emptying in patients with or without gastric pathology. Proximal gastric vagotomy performed in association with Nissen fundoplication augmented the speeding of gastric emptying, which was advantagenous in most cases but detrimental in two. Every patient in whom gastric emptying was not normalized had postoperative symptoms. Only two of 20 patients with normal postoperative gastric emptying had postoperative symptoms. Both patients had preexisting gastric pathology. Based on these findings, the side effects associated with Nissen fundoplication are due to the failure to normalize gastric emptying rather than the operation.
胃食管反流病患者出现胃排空延迟可能是由于食管下括约肌功能不全和/或胃部异常。为了确定nissen胃底折叠术对胃排空的影响，我们研究了25例经证实的胃食管反流病患者手术前后的胃排空率。9例患者无胃部病变，9例胃酸分泌过多，5例有胃炎，2例有明显的十二指肠胃反流证据。所有患者均接受nissen胃底折叠术治疗。胃酸分泌过多的患者还接受了近端胃迷走神经切断术（PGV），2例病理性十二指肠胃反流患者接受了胆汁转流手术。我们发现，在伴有胃部病变的胃食管反流病中，术前胃排空延迟的患病率高于无胃部病变的患者。nissen胃底折叠术与有或无胃部病变患者的胃排空加快有关。与nissen胃底折叠术联合进行的近端胃迷走神经切断术增强了胃排空的加快，这在大多数情况下是有利的，但在两例中是有害的。胃排空未恢复正常的每例患者术后都有症状。术后胃排空正常的20例患者中只有2例有术后症状。这两名患者都有既往胃部病变。基于这些发现，nissen胃底折叠术相关的副作用是由于胃排空未能恢复正常，而不是手术本身。
