Wu J M, Chen D
Department of Gastroesophageal Surgery, People's Liberation Army Rocket Force Characteristic Medical Center, Beijing 100088, China.
Zhonghua Wai Ke Za Zhi. 2020 Sep 1;58(9):677-682. doi: 10.3760/cma.j.cn112139-20200229-00162.
It has been nearly 70 years since the first attempt of surgical treatment for gastroesophageal reflux disease in Western countries, while in China, it is still in initial stage. Allison first attempted to control gastroesophageal reflux through surgical approach in 1951, but single hiatal hernia repair was inadequate to control reflux. Nissen developed fundoplication in 1955, and Rossetti modified it for reduction of the mobilized extent and related damage. The anti-reflux effect has been greatly improved but with high incidence of dysphagia and gas related complications. In order to solve these troublesome symptoms, Toupet and Dor came up with partial fundoplication, DeMeester and Donahue came up with "short floppy" Nissen fundoplication, they all successfully reduced the incidence of dysphagia and gas related complications but with preservation of anti-reflux effect.Thereafter, the three main stream fundoplication was formed (short floppy Nissen, Toupet and Dor procedures). In addition, other attempts for surgical control of gastroesophageal reflux were made, such as Belsey Mark Ⅳ, Hill and Collis procedures, but they are not as popular as fundoplication for a variety of reasons. In the meantime, the operative approach was converted from traditional laparotomy and thoracotomy to laparoscopic or robot-assisted laparoscopic era, and the anti-reflux effect was preserved with reduction in the duration of hospital stay and incidence of complications. Although plenty of anti-reflux procedures exists, they all with their own advantages and disadvantages, the concern for inadequate long-term anti-reflux effect and post-operative complications remains the main obstacle to the widespread of anti-reflux surgery. Better and more minimally invasive anti-reflux treatments should be explored.
西方国家首次尝试对胃食管反流病进行外科治疗至今已有近70年，而在中国，该治疗仍处于起步阶段。1951年，艾利森首次尝试通过手术方法控制胃食管反流，但单纯的食管裂孔疝修补术不足以控制反流。1955年，尼森发明了胃底折叠术，罗塞蒂对其进行了改良，以减少游离范围及相关损伤。抗反流效果有了很大改善，但吞咽困难和气体相关并发症的发生率较高。为了解决这些棘手的症状，图佩和多尔提出了部分胃底折叠术，德梅斯特和多纳休提出了“短而松弛”的尼森胃底折叠术，它们都成功降低了吞咽困难和气体相关并发症的发生率，但保留了抗反流效果。此后，形成了三种主流的胃底折叠术（短而松弛的尼森术、图佩术和多尔术）。此外，还进行了其他控制胃食管反流的手术尝试，如贝尔西马克Ⅳ术、希尔术和科利斯术，但由于各种原因，它们不如胃底折叠术受欢迎。与此同时，手术方式从传统的开腹和开胸手术转变为腹腔镜或机器人辅助腹腔镜时代，在保留抗反流效果的同时，缩短了住院时间，降低了并发症发生率。虽然存在大量的抗反流手术，但它们都各有优缺点，对长期抗反流效果不足和术后并发症的担忧仍然是抗反流手术广泛应用的主要障碍。应探索更好、创伤更小的抗反流治疗方法。
