Luostarinen M, Isolauri J, Laitinen J, Koskinen M, Keyriläinen O, Markkula H, Lehtinen E, Uusitalo A
Department of Clinical Medicine, University of Tampere, Finland.
Gut. 1993 Aug;34(8):1015-20. doi: 10.1136/gut.34.8.1015.
Of 46 patients who had Nissen fundoplication for proved gastro-oesophageal reflux, 25 were available for follow up after a median of 20 years, 15 had died of unrelated causes, and six could not be traced. All 25 patients in the follow up study were personally interviewed: 21 consented to an endoscopy, 14 to 24 hour recording of oesophageal pH and manometry, and 15 to radionuclide transit test. Repeat fundoplication for recurrent reflux was performed in two cases during the study. Heartburn and regurgitation were significantly lessened (p < 0.005), but the incidence of dysphagia was slightly increased. Endoscopy showed six of 21 fundic wraps to be defective. Erosive oesophagitis was seen in two patients, and Barrett's oesophagus (histologically confirmed) in one of them and six other patients. Total reflux time was abnormal in four of 14 patients. No patient with an intact fundic wrap seen on endoscopy, only two of seven with Barrett's oesophagus, and one of four with abnormal reflux had oesophagitis. Fundoplication in itself did not affect oesophageal motility or transit, provided that the wrap was intact. It is concluded that Nissen fundoplication gave a reasonably good longterm effect in chronic reflux disease, with the stage of the fundic wrap as the main determinant of outcome.
在46例因确诊为胃食管反流而接受nissen胃底折叠术的患者中，25例在中位时间20年后可供随访，15例死于无关原因，6例无法追踪到。随访研究中的所有25例患者均接受了个人访谈：21例同意接受内镜检查，14例同意进行食管pH值和测压的24小时记录，15例同意进行放射性核素通过试验。在研究期间，有2例因复发性反流而再次进行胃底折叠术。烧心和反流明显减轻（p<0.005），但吞咽困难的发生率略有增加。内镜检查显示21例胃底包裹中有6例有缺陷。2例患者出现糜烂性食管炎，其中1例经组织学证实为巴雷特食管，另外6例患者也患有巴雷特食管。14例患者中有4例总反流时间异常。内镜检查发现胃底包裹完整的患者中无一例发生食管炎，7例巴雷特食管患者中有2例，4例反流异常患者中有1例发生食管炎。只要包裹完整，胃底折叠术本身并不影响食管动力或通过情况。结论是，nissen胃底折叠术在慢性反流病中产生了相当好的长期效果，胃底包裹的状态是结果的主要决定因素。
