Ottignon Y, Pelissier E P, Mantion G, Clément C, Birgen C, Deschamps J P, Carayon P, Gillet M
Service de Gastroentérologie, CHU Jean-Minjoz.
Gastroenterol Clin Biol. 1994;18(11):920-6.
The aim of this prospective study was to evaluate and to compare the results of the circular fundoplication (Nissen) and the posterior hemifundoplication (Toupet) for the treatment of gastro-oesophageal reflux.
For each of the 71 included patients (Nissen, n:43; Toupet, n:28) the following data were collected: surgical complications, clinical symptoms, pH-metric and manometric data, before and 4 and 28 months after operation.
Rates of perioperative complications were 26% and 7% in the Nissen and Toupet groups respectively. The Nissen induced more late complications (14%) than the Toupet (0%). At early postoperative evaluation (mean follow-up: 4 months), the rates of clinical and pH-metric recurrences were 2% and 2.5% respectively in the Nissen group and 4% and 9% in the Toupet group (NS). Thirty-seven percent of the patients in the Nissen group and 38% in the Toupet group experienced dysphagia (NS). Disturbances in oesophageal motility, which were present in both groups before surgery, were not significantly modified. At the late evaluation (mean follow-up 28 months), some symptoms of reflux were present in 8% and 17% of patients of the Nissen and Toupet groups respectively (NS). The pH-metric recurrence rate was 10% versus 44% in the Nissen and Toupet groups respectively (P < 0.01). Dysphagia was present in 39% of patients in the Nissen group versus 13% in the Toupet group (P < 0.02). Oesophageal motility remained unchanged in the Nissen group whereas it was significantly improved in the Toupet group where the peristaltic velocity rose from 3.2 cm/s before surgery to 4.4 cm/s after (P < 0.05), giving a value comparable to that of controls (4.2 cm/s).
These results suggest that the short term effectiveness of both procedures is comparable. The effectiveness of the Nissen is more durable, but its morbidity is higher than for the Toupet. Moreover, oesophageal motility is significantly improved by the latter.
本前瞻性研究旨在评估和比较环形胃底折叠术（nissen术）和后半胃底折叠术（toupet术）治疗胃食管反流的效果。
纳入71例患者（nissen术组43例；toupet术组28例），收集手术并发症、临床症状、pH值监测和测压数据，分别于术前、术后4个月和28个月进行收集。
nissen术组和toupet术组围手术期并发症发生率分别为26%和7%。nissen术引起的晚期并发症（14%）多于toupet术（0%）。术后早期评估（平均随访4个月），nissen术组临床复发率和pH值监测复发率分别为2%和2.5%，toupet术组分别为4%和9%（无统计学差异）。nissen术组37%的患者和toupet术组38%的患者出现吞咽困难（无统计学差异）。两组术前均存在食管动力障碍，术后无明显改善。晚期评估（平均随访28个月），nissen术组和toupet术组分别有8%和17%的患者存在一些反流症状（无统计学差异）。pH值监测复发率nissen术组为10%，toupet术组为44%（P<0.01）。nissen术组39%的患者出现吞咽困难，toupet术组为13%（P<0.02）。nissen术组食管动力无变化，而toupet术组食管动力显著改善，蠕动速度从术前的3.2cm/s提高到术后的4.4cm/s（P<0.05），与对照组（4.2cm/s）相当。
这些结果表明，两种手术的短期疗效相当。nissen术的疗效更持久，但其发病率高于toupet术。此外，后者能显著改善食管动力。
