Miyano Go, Yamoto Masaya, Miyake Hiromu, Kaneshiro Masakatsu, Morita Keiichi, Nouso Hiroshi, Koyama Mariko, Okawada Manabu, Doi Takashi, Koga Hiroyuki, Lane Geoffrey J, Fukumoto Koji, Yamataka Atsuyuki, Urushihara Naoto
Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Asian J Endosc Surg. 2018 May;11(2):129-132. doi: 10.1111/ases.12430. Epub 2017 Sep 20.
We compared laparoscopic Toupet fundoplication (LTF) and laparoscopic Nissen fundoplication (LNF) in neurologically normal children.
Forty neurologically normal children who were followed up for more than 3 years after LTF (n = 22) or LNF (n = 18) were reviewed retrospectively. LTF and LNF were performed between 2006 and 2012.
There were no significant differences in gender (LTF, 15 male and 7 female patients; LNF:, 12 male and 6 female patients), mean age at surgery (LTF vs LNF: 2.5 vs 2.3 years), mean weight at surgery (LTF vs LNF: 9.6 vs 8.9 kg), preoperative symptoms, preoperative pH monitoring (pH <4) (LTF vs LNF: 26.7% vs 21.8%), mean operative time (LTF vs LNF: 117 vs 126 min), postoperative recommencement of enteral feeding (LTF vs LNF: 3.7 vs 3.8 days), or duration of hospitalization (LTF vs LNF: 5.5 vs 6.3 days). Intraoperative complications were esophageal trauma (LTF; n = 1; 4.5%) and liver trauma (LNF; n = 1; 5.6%) (P = 0.70). Post-LTF complications were wrap stenosis (n = 1; 4.5%), and post-LNF complications were wrap stenosis (n = 1; 5.5%) and gastric outlet obstruction (n = 1; 5.5%) (P = 0.43); all were managed conservatively. No case required conversion to open repair. There was no recurrence after LTF, but there were three cases (16.7%) after LNF (P = 0.08). Reoperation was performed at 4, 11, and 13 months, respectively.
Despite LTF and LNF appearing to be equally effective, three LNF cases required reoperation.
我们比较了腹腔镜下托佩特胃底折叠术（LTF）和腹腔镜下尼森胃底折叠术（LNF）在神经功能正常儿童中的应用。
回顾性分析了40例神经功能正常的儿童，这些儿童在接受LTF（n = 22）或LNF（n = 18）治疗后随访超过3年。LTF和LNF手术于2006年至2012年期间进行。
在性别（LTF组15例男性和7例女性患者；LNF组12例男性和6例女性患者）、手术时平均年龄（LTF组与LNF组：2.5岁 vs 2.3岁）、手术时平均体重（LTF组与LNF组：9.6 kg vs 8.9 kg）、术前症状、术前pH监测（pH < 4）（LTF组与LNF组：26.7% vs 21.8%）、平均手术时间（LTF组与LNF组：117分钟 vs 126分钟）、术后恢复肠内喂养时间（LTF组与LNF组：3.7天 vs 3.8天）或住院时间（LTF组与LNF组：5.5天 vs 6.3天）方面，两组之间均无显著差异。术中并发症包括食管损伤（LTF组；n = 1；4.5%）和肝脏损伤（LNF组；n = 1；5.6%）（P = 0.70）。LTF术后并发症为包绕狭窄（n = 1；4.5%），LNF术后并发症为包绕狭窄（n = 1；5.5%）和胃出口梗阻（n = 1；5.5%）（P = 0.43）；所有并发症均采用保守治疗。无一例需要转为开放修复手术。LTF术后无复发，但LNF术后有3例（16.7%）复发（P = 0.08）。分别在术后4个月、11个月和13个月进行了再次手术。
尽管LTF和LNF似乎同样有效，但LNF有3例需要再次手术。
