Wijnhoven B P, Salet G A, Roelofs J M, Smout A J, Akkermans L M, Gooszen H G
Department of Surgery, University Hospital Utrecht, The Netherlands.
Br J Surg. 1998 Feb;85(2):267-71. doi: 10.1046/j.1365-2168.1998.00505.x.
After Nissen fundoplication patients frequently report upper abdominal (dyspeptic) symptoms. Theoretically, these symptoms may be the result of changes in function of the proximal stomach as induced by fundoplication.
In this case-control study the response of the proximal stomach to both distension by an air-filled bag and a liquid meal were evaluated with the use of a barostat. In 12 patients after fundoplication and 12 healthy volunteers (age- and sex-matched) perception of symptoms was evaluated during both bag distension and liquid meal stimulus.
The minimal distending pressure required to overcome the intra-abdominal pressure was significantly different between patients and controls (mean(s.e.m.) 9.34(0.26) versus 6.73(0.43) mmHg; P < 0.001). There was no difference between groups in either the fasted state, volume-pressure curve (compliance) or total symptom score. After ingestion of the liquid meal the adaptive relaxation in the fundoplication group was significantly less than that in controls (mean(s.e.m.) 150(29.2) versus 244(34.8) ml; P = 0.04).
This study showed that after Nissen fundoplication compliance of the proximal stomach is no different from that in healthy volunteers. Postprandial relaxation of the proximal stomach is decreased and this abnormality may be involved in the pathogenesis of reported dyspeptic symptoms.
nissen胃底折叠术后患者常报告上腹部（消化不良）症状。理论上，这些症状可能是胃底折叠术引起的近端胃功能改变的结果。
在这项病例对照研究中，使用恒压器评估近端胃对充气袋扩张和流食的反应。在12例胃底折叠术后患者和12名健康志愿者（年龄和性别匹配）中，在气囊扩张和流食刺激期间评估症状感知。
患者和对照组之间克服腹内压所需的最小扩张压力有显著差异（均值（标准误）9.34（0.26）对6.73（0.43）mmHg；P<0.001）。两组在禁食状态、容积-压力曲线（顺应性）或总症状评分方面均无差异。摄入流食后，胃底折叠术组的适应性舒张明显低于对照组（均值（标准误）150（29.2）对244（34.8）ml；P=0.04）。
本研究表明，nissen胃底折叠术后近端胃的顺应性与健康志愿者无异。餐后近端胃舒张减弱，这种异常可能与所报告的消化不良症状的发病机制有关。
