Martinez J M, Halverson A, Magnuson D K, Sackier J M
George Washington University Medical Center, Washington, DC 20037, USA.
J Laparoendosc Adv Surg Tech A. 1997 Oct;7(5):323-6. doi: 10.1089/lap.1997.7.323.
Differences in outcome and cost of laparoscopic and open surgery are continuously being evaluated. Two-year-old monozygotic twin boys with a previous history of prematurity, severe gastroesophageal reflux disease, and intractable reactive airway disease were each scheduled to undergo a laparoscopic Nissen fundoplication (LNF) on the same day. Current medications for both patients included albuterol, cromolyn sodium, dexamethasone, ranitidine, and metoclopramide. In the first case, the laparoscopic procedure was converted to an open Nissen fundoplication (ONF) to gain expeditious control of bleeding from a short gastric vessel close to the spleen. The second patient underwent LNF without complication. Operative time for each patient was 3.5 h. The postoperative length of stay for each patient was 6 days (ONF) and 4 days (LNF). The total hospital charges were $21,931 (ONF) and $19,108 (LNF). The first patient (ONF) was readmitted later on the day of discharge (postoperative day 6) for vomiting and was discharged after 24 h with no further treatment. The subsequent course of each patient was similar. At a 6-week follow-up visit, both patients were tolerating a regular diet with weight gain and dramatic improvement in pulmonary symptoms.
腹腔镜手术和开放手术在疗效和成本方面的差异一直在持续评估中。两名两岁的单卵双胞胎男孩，有早产、严重胃食管反流病和难治性反应性气道疾病史，两人同一天均计划接受腹腔镜下尼森胃底折叠术（LNF）。两名患者目前的用药均包括沙丁胺醇、色甘酸钠、地塞米松、雷尼替丁和甲氧氯普胺。第一例手术中，腹腔镜手术转为开放尼森胃底折叠术（ONF），以便迅速控制靠近脾脏的胃短血管出血。第二例患者接受LNF手术，未出现并发症。每名患者的手术时间均为3.5小时。每名患者的术后住院时间分别为6天（ONF）和4天（LNF）。总住院费用分别为21,931美元（ONF）和19,108美元（LNF）。第一名患者（ONF）在出院当天（术后第6天）因呕吐再次入院，24小时后未经进一步治疗出院。每名患者随后的病程相似。在6周的随访中，两名患者均能耐受常规饮食，体重增加，肺部症状显著改善。
