Henderson R D, Marryatt G
J Thorac Cardiovasc Surg. 1983 Jan;85(1):81-7.
Total fundoplication gastroplasty was designed to combine the low anatomic recurrence rate of gastroplasty with the effectiveness of reflux control obtained by total wrap. The problems requiring evaluation are anatomic recurrence, continued reflux, dysphagia, inability to belch or vomit, and gas bloat, all of which have been described in procedures employing a total wrap. Five hundred consecutive patients were analyzed 6 to 60 months following operation. There were no deaths and a 3.6% incidence of short-term operative morbidity. Follow-up was available clinically in 98.4% (495 patients), radiologically in 89.6% (448), and manometrically in 69.5% (347). Two patients have anatomic recurrence (0.4%) and none has reflux. Excellent results occurred in 93.4% (467), improvement in 5% (25), and poor results in 1.6% (eight). Repeat operation was necessary in 0.4% (two) for recurrence and in 0.8% (four) for severe dysphagia. The other problems were minor dysphagia in 2.2% (11), gastritis in 1.2% (six), late cholelithiasis in 0.4% (two), and continued pain with poor results in 0.4% (two). The length of the gastroplasty tube and the subdiaphragmatic position of the high-pressure zone (HPZ) did not affect the result of the operation. A long tube and unwrapped supradiaphragmatic HPZ was present in 18.8% (94); none had reflux or major dysphagia. Total length of the gastroplasty wrap was 3 to 4 cm in the first 200 and the incidence of major dysphagia was 5% (10). Reducing the length of fundoplication to 1.5 to 2 cm reduced the incidence of dysphagia to 1.7% (five). Other problems of gastritis and difficulty with belching and vomiting occurred in a random fashion. This procedure is effective in reflux control, prevents anatomic recurrence and, if the completed fundoplication is maintained at 1.5 to 2 cm, yields a low incidence of significant dysphagia.
全胃底折叠胃成形术旨在将胃成形术较低的解剖学复发率与全包裹获得的反流控制效果相结合。需要评估的问题包括解剖学复发、持续反流、吞咽困难、无法嗳气或呕吐以及气体潴留，所有这些问题在采用全包裹的手术中均有描述。对连续500例患者在术后6至60个月进行了分析。无死亡病例，短期手术并发症发生率为3.6%。98.4%（495例患者）有临床随访，89.6%（448例）有影像学随访，69.5%（347例）有测压随访。2例患者出现解剖学复发（0.4%），无反流病例。93.4%（467例）效果极佳，5%（25例）有所改善，1.6%（8例）效果不佳。0.4%（2例）因复发、0.8%（4例）因严重吞咽困难需要再次手术。其他问题包括2.2%（11例）有轻度吞咽困难、1.2%（6例）有胃炎、0.4%（2例）有晚期胆结石以及0.4%（2例）持续疼痛且效果不佳。胃成形术管的长度和高压区（HPZ）在膈下的位置不影响手术结果。18.8%（94例）存在长管且膈上HPZ未包裹；均无反流或严重吞咽困难。在前200例患者中，胃成形术包裹的总长度为3至4厘米，严重吞咽困难的发生率为5%（10例）。将胃底折叠长度减至1.5至2厘米可使吞咽困难的发生率降至1.7%（5例）。胃炎以及嗳气和呕吐困难等其他问题随机出现。该手术在控制反流方面有效，可防止解剖学复发，并且如果完成的胃底折叠保持在1.5至2厘米，严重吞咽困难的发生率较低。
