Watson D I, Jamieson G G, Baigrie R J, Mathew G, Devitt P G, Game P A, Britten-Jones R
Royal Adelaide Centre for Endoscopic Surgery, University Department of Surgery, Adelaide, South Australia.
Br J Surg. 1996 Sep;83(9):1284-7.
From September 1991 to October 1995, 320 Nissen fundoplications were undertaken laparoscopically by 12 surgeons at a single institution. To assess the performance of the procedure in the hands of five 'experienced' surgeons, the first 20 procedures performed by each surgeon or surgical trainee were excluded, providing a group of 174 patients for review. A short loose 360 degrees fundoplication was performed in all instances, with short gastric vessel division performed in 35.0 per cent of patients and hiatal repair in 66.7 per cent. Median operating time was 80 (range 30-210) min and median postoperative stay was 3 (range 1-19) days. Sixteen procedures (9.2 per cent) could not be completed laparoscopically and required conversion to open surgery. Some 144 patients were reviewed by a scientific officer 3 months after surgery, 85 at 12 months, and 32 at 2 years, using a standard clinical questionnaire. All but one were free from reflux symptoms, although 20.1 per cent reported some dysphagia at 3 months' follow-up; this figure declined to 11 per cent at 12 months and 6 per cent (two of 34 patients) at 2 years. At each follow-up interval, 91 per cent of patients were satisfied with the outcome of the surgery. Objective testing with oesophageal motility (75 patients) and barium swallow (113) studies 3-6 months after surgery confirmed the clinical outcome. Complications occurred in nine patients (5.2 per cent); four (2.3 per cent) of these required a subsequent operation within 30 days of surgery for bleeding (one patient), paraoesophageal herniation (one) and dysphagia (two). A further procedure was necessary in six other patients (3.4 per cent) for late problems, including paraoesophageal herniation (two), hiatal stenosis (three) and gastric obstruction (one). Revision was performed laparoscopically in two patients. The clinical results of laparoscopic Nissen fundoplication by 'experienced' laparoscopic surgeons were comparable with those of open surgery.
1991年9月至1995年10月，一家机构的12位外科医生对320例患者实施了腹腔镜下尼氏胃底折叠术。为评估5位“经验丰富”的外科医生实施该手术的效果，每位外科医生或外科实习生所做的前20例手术被排除，最终纳入174例患者进行回顾性研究。所有患者均采用短而宽松的360度胃底折叠术，35.0%的患者同时切断了胃短血管，66.7%的患者进行了裂孔修补。手术中位时间为80（30 - 210）分钟，术后中位住院时间为3（1 - 19）天。16例手术（9.2%）无法通过腹腔镜完成，需转为开放手术。术后3个月，一名科研人员使用标准临床问卷对约144例患者进行了随访，12个月时随访85例，2年时随访32例。除1例患者外，所有患者均无反流症状，不过在3个月随访时，20.1%的患者报告有吞咽困难；12个月时这一比例降至11%，2年时降至6%（34例患者中的2例）。在每次随访时，91%的患者对手术结果满意。术后3 - 6个月对75例患者进行食管动力测试、113例患者进行吞钡检查，客观测试结果证实了临床疗效。9例患者（5.2%）出现并发症；其中4例（2.3%）在术后30天内需再次手术，分别是因出血（1例）、食管旁疝（1例）和吞咽困难（2例）。另外6例患者（3.4%）因后期问题需再次手术，包括食管旁疝（2例）、裂孔狭窄（3例）和胃梗阻（1例）。2例患者通过腹腔镜进行了翻修手术。“经验丰富”的腹腔镜外科医生实施腹腔镜下尼氏胃底折叠术的临床效果与开放手术相当。
