Naunheim K S, Landreneau R J, Andrus C H, Ferson P F, Zachary P E, Keenan R J
Department of Surgery, Saint Louis University Health Sciences Center, Missouri 63110-0250, USA.
Ann Thorac Surg. 1996 Apr;61(4):1062-5. doi: 10.1016/0003-4975(96)00071-9.
Thoracic surgeons have historically played a significant role in surgical treatment of benign esophageal disorders. With the advent of video-assisted thoracic surgical techniques, chest surgeons have also become adept at minimally invasive procedures. Thus, it seems appropriate that thoracic surgeons participate in minimally invasive antireflux operations, such as laparoscopic Nissen fundoplication.
From February 1993 to May 1995, 66 patients (32 male, 34 female) with a mean age of 45.5 years (range, 15 to 82 years) underwent a laparoscopic fundoplication. Gastroesophageal reflux disease was diagnosed on the basis of history and endoscopically documented esophagitis or abnormal esophageal pH testing or both. There were 45 type I, 3 type II, and 7 type III hiatal hernias. Eleven patients had gastroesophageal reflux disease with no hernia.
Conversion to laparotomy occurred in 6 patients (9%) due to bleeding in 2 patients, inability to expose the gastroesophageal junction in 3, and gastric laceration in 1 patient. All but 1 patient underwent a Nissen fundoplication performed over a 50F to 60F dilator. The remaining patient (type II hernia without gastroesophageal reflux disease) underwent a reduction, closure, and anterior gastropexy. There was no operative mortality. Immediate postoperative morbidity included moderate dysphagia in 7 patients (11%), ileus in 2 patients (3%), and deep venous thrombosis and atrial arrhythmia in 1 each (1.5%). Excluding 1 patient hospitalized for 42 days due to severe psychosis, the mean postoperative stay was 4.0 +/- 2.5 days (median, 3 days). Three patients (5%) required dilation for dysphagia, and 1 (1.5%) has noted recurrent reflux during follow-up (mean, 14.4 months; range, 6 to 30 months). A single patient has undergone reoperation for persistent dysphagia (1.5%).
A laparoscopic Nissen procedure is safe, effective treatment for refractory gastroesophageal reflux disease when performed by thoracic surgeons experienced in minimally invasive surgical procedures.
胸外科医生在良性食管疾病的外科治疗中一直发挥着重要作用。随着电视辅助胸外科技术的出现，胸外科医生也已熟练掌握微创手术。因此，胸外科医生参与微创抗反流手术，如腹腔镜尼氏胃底折叠术，似乎是合适的。
1993年2月至1995年5月，66例患者（男32例，女34例）接受了腹腔镜胃底折叠术，平均年龄45.5岁（范围15至82岁）。根据病史以及内镜证实的食管炎或异常食管pH检测结果或两者，诊断胃食管反流病。有45例I型、3例II型和7例III型食管裂孔疝。11例患者有胃食管反流病但无疝。
6例患者（9%）中转开腹，原因是2例出血、3例无法暴露胃食管交界处、1例胃撕裂伤。除1例患者外，所有患者均在50F至60F扩张器上进行尼氏胃底折叠术。其余患者（无胃食管反流病的II型疝）进行了复位、缝合和前胃固定术。无手术死亡。术后即刻并发症包括7例患者（11%）中度吞咽困难、2例患者（3%）肠梗阻、各1例患者（1.5%）深静脉血栓形成和房性心律失常。排除1例因严重精神病住院42天的患者，术后平均住院时间为4.0±2.5天（中位数3天）。3例患者（5%）因吞咽困难需要扩张，1例患者（1.5%）在随访期间（平均14.4个月；范围6至30个月）出现反流复发。1例患者因持续性吞咽困难再次手术（1.5%）。
由有微创手术经验的胸外科医生进行腹腔镜尼氏手术，是治疗难治性胃食管反流病的安全、有效方法。
