Champault G, Volter F, Rizk N, Boutelier P
Service de Chirurgie Générale et Digestive, Hôpital Jean Verdier, Université Paris XIII, Bondy, France.
J Chir (Paris). 1995 Aug-Sep;132(8-9):325-31.
61 patients with aggressive gastro-esophageal reflux have been prospectively treated, 29 by open surgery and 32 by laparoscopy. There is no mortality and the morbidity is not significantly different (3 per cent vs 5 per cent). Hospital stay is strongly reduced in the laparoscopic group (5.4 days vs 8.9 days p = 0.02). Either the period of no professional activity (21.3 days vs 38.2 days p = 0.02). In both group, dysphagia is noted in 30% of the patients at 1 month and 3% at 4 months. All patients have had pre-operatively a mano-Ph-metry evaluation. At 4 months, the follow-up rate is 100% and all patient have been controlled with a 24 hours mano-Ph-metry. There is no difference between open and laparoscopic surgery. The mean SIO pressure had increased in both group from 3.6 mmHg to 18.1 mmHg (p = 0.001). There is only one failure in the beginning of the learning curve (4th patients in the "laparoscopy group" (3.1%). These study suggest that laparoscopic treatment could be proposed in the majority of failures of medical treatment in gastro-oesophageal reflux.
61例侵袭性胃食管反流患者接受了前瞻性治疗，29例接受开放手术，32例接受腹腔镜手术。无死亡病例，发病率无显著差异（3%对5%）。腹腔镜组的住院时间大幅缩短（5.4天对8.9天，p = 0.02）。非职业活动期也是如此（21.3天对38.2天，p = 0.02）。两组中，1个月时30%的患者出现吞咽困难，4个月时为3%。所有患者术前均进行了食管测压评估。4个月时，随访率为100%，所有患者均通过24小时食管测压进行了检查。开放手术和腹腔镜手术之间没有差异。两组的平均下食管括约肌压力均从3.6 mmHg升至18.1 mmHg（p = 0.001）。在学习曲线初期只有1例失败病例（“腹腔镜组”的第4例患者，占3.1%）。这些研究表明，对于大多数胃食管反流药物治疗失败的患者，可以采用腹腔镜治疗。
