Hill 胃固定术联合 Nissen 胃底折叠术在短食管的治疗中与 Collis-Nissen 术式效果相当。
A Hill Gastropexy Combined with Nissen Fundoplication Appears Equivalent to a Collis-Nissen in the Management of Short Esophagus.
机构信息
Division of General Surgery, Swedish Medical Center, Seattle, WA, USA.
Division of Thoracic Surgery, Swedish Medical Center, 1101 Madison St., Suite 900, Seattle, WA, 98104, USA.
出版信息
J Gastrointest Surg. 2018 Mar;22(3):389-395. doi: 10.1007/s11605-017-3598-4. Epub 2017 Oct 2.
INTRODUCTION
A Collis gastroplasty combined with a Nissen fundoplication is commonly used when a shortened esophagus is encountered. An alternative combines intra-abdominal fixation of the gastroesophageal junction via a Hill gastropexy with a Nissen fundoplication to maintain length and avoid juxtaposing acid-secreting tissue against the diseased esophagus.
METHODS
A retrospective case-controlled analysis of 106 consecutive patients with short esophagus undergoing Hill-Nissen (HN) or Collis-Nissen (CN) was compared to a cohort of 105 matched patients without short esophagus undergoing primary Nissen fundoplication (NF).
RESULTS
At a median follow-up of 27 months, all groups (HN:CN:NF) improved significantly over preoperative baseline with no differences in overall complications (18 vs 16 vs 19%, p = 0.78), DeMeester score (11.1 vs 19.1 vs 14.2, p = 0.49), postoperative PPI use (16 vs 22 vs 15%, p = 0.24), anatomic recurrences (11.7 vs 5.5 vs 7%, p = 0.43), or quality of life (6.8 vs 6.7 vs 6.4, p = 0.3).
CONCLUSIONS
The management of shortened esophagus with Hill-Nissen is safe and as effective as Collis gastroplasty with Nissen fundoplication. Both options appear to produce similar outcomes to patients requiring only a Nissen fundoplication suggesting a shortened esophagus does not beget an inferior outcome.
简介
当遇到缩短的食管时，通常会采用 Collis 胃底折叠术联合 Nissen 胃底折叠术。另一种方法是通过 Hill 胃固定术将胃食管交界处固定在腹腔内，同时进行 Nissen 胃底折叠术，以维持长度并避免将分泌胃酸的组织与患病的食管相邻。
方法
回顾性分析了 106 例接受 Hill-Nissen（HN）或 Collis-Nissen（CN）手术的短食管患者，并与 105 例无短食管的接受原发性 Nissen 胃底折叠术（NF）的患者进行了匹配对照。
结果
中位随访 27 个月时，所有组（HN：CN：NF）与术前基线相比均有显著改善，总体并发症发生率无差异（18%比 16%比 19%，p=0.78），DeMeester 评分（11.1 比 19.1 比 14.2，p=0.49），术后 PPI 使用（16%比 22%比 15%，p=0.24），解剖学复发（11.7%比 5.5%比 7%，p=0.43）或生活质量（6.8%比 6.7%比 6.4%，p=0.3）。
结论
Hill-Nissen 治疗缩短的食管是安全的，与 Collis 胃底折叠术联合 Nissen 胃底折叠术一样有效。这两种方法似乎都能为仅需要 Nissen 胃底折叠术的患者带来相似的结果，这表明缩短的食管不会产生较差的结果。
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