Kiviluoto T, Luukkonen P, Salo J
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Ann Chir Gynaecol. 1994;83(2):101-6.
Recent improvement in the understanding of gastro-oesophageal antireflux mechanisms and the pathophysiology of the gastro-oesophageal reflux disease (GERD) has warranted the concept that antireflux surgery provides a valid, and sometimes superior, alternative to medical therapy in selected patients. The main indications for surgical treatment of symptomatic GERD are: failure of medical therapy to heal ulcerative oesophagitis or to prevent recurrence of stricture or other complications, and the development of aspiration pneumonia or other airway complications. The Belsey and Nissen fundoplication and the Hill posterior gastropexy are the three most widely used surgical procedures to control reflux. The success rate of these operations, performed openly, in relieving symptoms and healing the lesions is 80-90%. The laparoscopic approach provides an interesting alternative in antireflux surgery. It affords a potential to reduce some inherent complications of conventional surgery, provided the operator is technically experienced and well aware of the pathophysiological principles of this disease. It is also superbly convenient to the patient. The currently published short-term results of laparoscopic antireflux surgery are comparable to those of open surgery, but the technique is still young, and its final evaluation is not possible until long-term results are available.
近年来，对胃食管抗反流机制及胃食管反流病（GERD）病理生理学的认识取得了进展，这使得抗反流手术在特定患者中成为一种有效的、有时甚至更优的替代药物治疗的观念得到认可。有症状的GERD手术治疗的主要指征为：药物治疗无法治愈溃疡性食管炎或预防狭窄或其他并发症的复发，以及发生吸入性肺炎或其他气道并发症。贝尔西（Belsey）手术、nissen胃底折叠术和希尔（Hill）后胃固定术是控制反流最常用的三种外科手术。这些开放手术在缓解症状和治愈病变方面的成功率为80% - 90%。腹腔镜手术方法为抗反流手术提供了一种有吸引力的替代方案。只要手术者技术娴熟且充分了解该疾病的病理生理原则，它就有可能减少传统手术的一些固有并发症。对患者来说也极为方便。目前已发表的腹腔镜抗反流手术的短期结果与开放手术相当，但该技术仍不成熟，在获得长期结果之前无法进行最终评估。
