Alexander H C, Hendler R S, Seymour N E, Shires G T
Department of Surgery, Doctors Hospital, Dallas, Texas, USA.
Am Surg. 1997 May;63(5):434-40.
Laparoscopic fundoplication is technically feasible in treating gastroesophageal reflux disease (GERD). Although medication is the primary treatment for GERD, not all patients respond completely or are able to adhere to a medical regimen. In the present series, 59 patients were laparoscopically treated for GERD at three centers using a standardized technique. All patients had been medically treated prior to referral, although 84 per cent had heartburn and 2 per cent had laryngitis despite 20 to 40 mg/day of omeprazole. Fifteen per cent of patients were intolerant of or would no longer take omeprazole. Patients were evaluated by esophageal manometry (in 100%) and 24-hour pH studies (in 66%). Seventy-six per cent of patients had lower-esophageal sphincter pressure <15 mm Hg. Five patients had low esophageal body peristaltic pressures (<35 mm Hg). These patients underwent Toupet partial fundoplication, whereas 54 patients underwent Nissen fundoplication. Mean operative time was 158 +/- 7 minutes, and three patients (5%) were converted to an open procedure. Operative complications were minor and occurred in 13 per cent. In 45 patients evaluated 1 year after surgery, heartburn had resolved in 98 per cent. Thirty-nine of 56 patients (70%) had mild early (<1 month postoperatively) dysphagia, and 9 (19%) had severe early dysphagia, which improved in 7 after nonoperative dilatation. Two of these had continued mild dysphagia. Two patients had severe dysphagia and were laparoscopically converted from Nissen to Toupet fundoplications, which resulted in marked improvement. Early gas bloat symptoms occurred in 45 per cent and dropped to 5 per cent at 1 year. Laparoscopic treatment of GERD is safe and effective in preventing reflux symptoms. Although mild dysphagia occurs after the procedure, this is transient in most patients. Patients with severe dysphagia can be treated with nonoperative dilatation or laparoscopic partial fundoplication and maintain the antireflux characteristics of the wrap.
腹腔镜胃底折叠术在治疗胃食管反流病（GERD）方面技术上是可行的。尽管药物治疗是GERD的主要治疗方法，但并非所有患者都能完全缓解或坚持药物治疗方案。在本系列研究中，三个中心使用标准化技术对59例GERD患者进行了腹腔镜治疗。所有患者在转诊前均接受过药物治疗，尽管每天服用20至40毫克奥美拉唑，但仍有84%的患者有烧心症状，2%的患者有喉炎症状。15%的患者不耐受或不再服用奥美拉唑。通过食管测压（100%）和24小时pH值研究（66%）对患者进行评估。76%的患者食管下括约肌压力<15毫米汞柱。5例患者食管体蠕动压力较低（<35毫米汞柱）。这些患者接受了Toupet部分胃底折叠术，而54例患者接受了Nissen胃底折叠术。平均手术时间为158±7分钟，3例患者（5%）转为开放手术。手术并发症轻微，发生率为13%。在术后1年接受评估的45例患者中，98%的患者烧心症状得到缓解。56例患者中有39例（70%）术后早期（术后<1个月）出现轻度吞咽困难，9例（19%）出现严重早期吞咽困难，其中7例经非手术扩张后症状改善。其中2例仍有轻度吞咽困难。2例患者有严重吞咽困难，经腹腔镜将Nissen胃底折叠术改为Toupet胃底折叠术后症状明显改善。早期胃胀症状发生率为45%，1年后降至5%。腹腔镜治疗GERD在预防反流症状方面是安全有效的。尽管术后会出现轻度吞咽困难，但大多数患者的这种情况是短暂的。严重吞咽困难的患者可通过非手术扩张或腹腔镜部分胃底折叠术进行治疗，并保持胃底折叠术的抗反流特性。
