Luostarinen M
Department of Surgery, Tampere University Hospital, Finland.
Ann Chir Gynaecol. 1995;84(2):115-20.
Since its introduction by Rudolph Nissen in 1956, fundoplication has become the most commonly used antireflux procedure. Following fundoplication the majority (80 to 90%) of the patients become symptomfree or have only mild and occasional reflux symptoms in the long run. With a short and loose fundic wrap postoperative dysphagia is not a clinical problem, providing that preoperative manometry shows adequate peristalsis. Flatus is increased after fundoplication, but rarely to a disturbing extent. Patients who have problems with flatus preoperatively are also prone to have complaints postoperatively. Bloating is decreased rather than increased after fundoplication. At endoscopy as intact seen fundic wrap (the main determinant of the long-term outcome) is observed in 70% to 80% of the cases 10 to 20 years after the operation. Oesophageal 24-hour pH-recording is normal and oesophagitis cured in similar number of patients. In conclusion, Nissen fundoplication gives effective cure of symptoms of gastro-oesophageal reflux disease and reliably corrects reflux oesophagitis. Postoperative adverse effects are rare and well tolerable and do not detract from the success of the operation in correctly selected patients.
自1956年鲁道夫·尼森引入该手术以来，胃底折叠术已成为最常用的抗反流手术。胃底折叠术后，大多数（80%至90%）患者最终症状消失或仅出现轻微且偶尔的反流症状。如果术前食管测压显示蠕动正常，采用短而宽松的胃底包裹术时，术后吞咽困难并非临床问题。胃底折叠术后胃肠胀气会增加，但很少达到令人困扰的程度。术前有胃肠胀气问题的患者术后也容易出现相关不适。胃底折叠术后腹胀会减轻而非加重。术后10至20年，70%至80%的病例在内镜检查中可见完整的胃底包裹（这是长期疗效的主要决定因素）。相当数量的患者24小时食管pH监测结果正常，食管炎得到治愈。总之，尼森胃底折叠术能有效治愈胃食管反流病症状，并可靠地纠正反流性食管炎。术后不良反应罕见且耐受性良好，在正确选择的患者中，这些不良反应并不影响手术的成功。
