Kiviluoto T, Sirén J, Färkkilä M, Luukkonen P, Salo J, Kivilaakso E
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Surg Laparosc Endosc. 1998 Dec;8(6):429-34.
Nissen fundoplication is now the most common antireflux operation for gastroesophageal reflux disease. This study is a report on the laparoscopically performed floppy Nissen procedure. Two hundred consecutive patients were analyzed (84 women, 116 men, mean age 49 years, mean duration of symptoms 5 years) after laparoscopic Nissen fundoplication between 1992 and 1996. The main indications for surgery were daily heartburn, retrosternal pain, and regurgitation demanding continuous medical therapy. Eight patients (4%) had esophageal stricture, and 21 (11%) had Barrett's esophagus with intestinal metaplasia. All patients underwent upper gastrointestinal endoscopy, 24-h esophageal pH monitoring, and esophageal manometry before and 3 months after the operation. In addition, a questionnaire was completed an average of 2.2 years (range 1.0-4.6) after the operation. The results of the study were as follows: mortality was zero, and the morbidity rate was 5%. The mean hospital stay was 3.8 +/- 2.8 days, and sick leave was 14.3 +/- 10.4 days. Postoperatively, esophagitis was healed or significantly improved in all but 4 patients (98%), and 24-h pH and lower esophageal sphincter pressure were normal. After 2 years, 87% of the patients had Visick scores of I-II. It is concluded that laparoscopic floppy Nissen fundoplication provides an efficient and safe alternative for surgical treatment of gastroesophageal reflux disease.
nissen胃底折叠术是目前治疗胃食管反流病最常用的抗反流手术。本研究报告了腹腔镜下进行的软性nissen手术。对1992年至1996年间接受腹腔镜nissen胃底折叠术的200例连续患者（84例女性，116例男性，平均年龄49岁，平均症状持续时间5年）进行了分析。手术的主要指征是每日烧心、胸骨后疼痛和反流，需要持续药物治疗。8例患者（4%）有食管狭窄，21例（11%）有伴有肠化生的巴雷特食管。所有患者在手术前和手术后3个月均接受了上消化道内镜检查、24小时食管pH监测和食管测压。此外，在手术后平均2.2年（范围1.0 - 4.6年）完成了一份问卷调查。研究结果如下：死亡率为零，发病率为5%。平均住院时间为3.8±2.8天，病假为14.3±10.4天。术后，除4例患者外（98%），食管炎均愈合或明显改善，24小时pH值和食管下括约肌压力均正常。2年后，87%的患者Visick评分为I - II级。结论是腹腔镜软性nissen胃底折叠术为胃食管反流病的手术治疗提供了一种有效且安全的选择。
