Meyer C, Rohr S, De Manzini N, Firtion O, Thiry L, Bourtoul C
Service de Chirurgie Générale et Digestive, CHU Hautepierre, Strasbourg.
Ann Chir. 1998;52(7):598-601.
The aim of this study was to see whether the results of surgical treatment of gastroesophageal reflux disease (GERD) by laparoscopic fundoplication were satisfactory and stable over time.
From July 1992 to September 1996, 161 patients with medical treatment-dependent GERD were operated. 17 patients were excluded from the study (conversion or immediate laparotomy). The group of 144 patients included consisted of 92 men and 52 women with a mean age of 50 (25-77 years). The preoperative work-up included endoscopy, esophageal manometry and 24-hour pH monitoring. The surgical procedures were complete fundoplication without section of the short vessels (Nissen-Rossetti: 122 cases), with section of the shorts vessels (Nissen: 18 cases), or partial fundoplication of 270 degrees (Toupet: 4 cases). The patients were reviewed clinically 3 months after the operation, with repeat manometry and pH monitoring; yearly survey was performed.
There was no postoperative mortality. The morbidity consisted of 2 respiratory complications (1.5%) with good recovery. With a follow-up of 3 and 21 months, the dysphagia rate was 24 vs 2% of patients (p < 0.05), the rate of gas bloat syndrome was 18% vs 21% (n.s.), and the GERD recurrence 6% vs 14% (p < 0.05). The mean time to recurrence was 8 months. 2 patients were reoperated: one for incisional hernia and one for slipped-Nissen.
The results of laparoscopic treatment of GERD with fundoplication procedures at 2 years follow-up showed an 86% cure rate of GERD control and 94% satisfaction rate for the patients who were investigated.
本研究的目的是观察腹腔镜胃底折叠术治疗胃食管反流病（GERD）的结果随时间推移是否令人满意且稳定。
1992年7月至1996年9月，对161例依赖药物治疗的GERD患者进行了手术。17例患者被排除在研究之外（中转开腹或急诊开腹）。纳入研究的144例患者中，男性92例，女性52例，平均年龄50岁（25 - 77岁）。术前检查包括内镜检查、食管测压和24小时pH监测。手术方式包括不切断短血管的完全胃底折叠术（nissen - rossetti术式：122例）、切断短血管的胃底折叠术（nissen术式：18例）或270度部分胃底折叠术（Toupet术式：4例）。术后3个月对患者进行临床复查，重复测压和pH监测；每年进行一次随访。
无术后死亡病例。并发症包括2例呼吸并发症（1.5%），恢复良好。随访3个月和21个月时，吞咽困难发生率分别为24%和2%（p < 0.05），气体膨胀综合征发生率分别为18%和21%（无统计学差异），GERD复发率分别为6%和14%（p < 0.05）。复发的平均时间为8个月。2例患者再次手术：1例因切口疝，1例因nissen胃底折叠术滑脱。
对接受胃底折叠术式的GERD患者进行腹腔镜治疗，2年随访结果显示GERD控制治愈率为86%，接受调查的患者满意度为94%。
