Trastek V F, Deschamps C, Allen M S, Miller D L, Pairolero P C, Thompson A M
Section of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 1998 Nov;66(5):1739-44. doi: 10.1016/s0003-4975(98)00993-x.
Between September 1985 and July 1990, the first 100 consecutive patients (50 female and 50 male) undergoing primary uncut Collis-Nissen fundoplication performed by one surgeon were reviewed.
Median age was 62 years and ranged from 19 to 89 years. Indications for repair included gastroesophageal reflux in 56 patients, obstructive symptoms in 34, and a combination of both in 10. An upper gastrointestinal endoscopy was performed in 99 patients; all were abnormal. Esophagitis was documented in 53 patients, large diaphragmatic hernia in 36, stenosis in 18, "Cameron's erosions" in 17, Barrett's disease in 13, and other findings in 9 patients. An abnormal upper gastrointestinal series was demonstrated in 96 of 97 patients evaluated. Motility studies were performed in 95 patients, and 11 had abnormal peristalsis. All procedures were performed through a left thoracotomy.
Complications occurred in 23 patients and included respiratory failure in 6, atrial fibrillation in 3, atelectasis in 3, pneumonia in 2, myocardial infarction in 2, and chylothorax, severe dysphagia, early breakdown of repair, cardiac tamponade, hematuria, spinal headache, and intraoperative perforation by dilator in 1 each. There were 2 postoperative deaths, both cardiac in origin. Median hospitalization was 8 days (range, 6 to 76 days). The first 25 patients had 10 complications (40%) and 2 deaths (8%). The remaining 75 patients had 13 complications (17%) and no deaths (mortality, p = 0.06; morbidity, p = 0.03). Follow-up was complete in all patients for a median of 100 months (range, 3 to 138 months). Eighty-six of the 98 operative survivors are currently alive. At last follow-up, excellent functional results were observed in 58 patients (59%), good in 24 (25%), fair in 8 (8%), poor in 7 (7%), and unknown in 1 (1%).
We conclude that the uncut Collis-Nissen fundoplication provides good to excellent long-term results in 84% of patients. Operative mortality and morbidity is acceptable but is associated with a learning curve.
1985年9月至1990年7月期间，对由一位外科医生实施的首例连续100例（50例女性和50例男性）原发性未切断Collis-Nissen胃底折叠术患者进行了回顾性研究。
患者年龄中位数为62岁，范围为19至89岁。修复指征包括56例胃食管反流、34例梗阻症状以及10例两者兼具。99例患者接受了上消化道内镜检查；结果均异常。53例患者记录有食管炎，36例有大型膈疝，18例有狭窄，17例有“卡梅伦糜烂”，13例有巴雷特病，9例有其他发现。在接受评估的97例患者中，96例上消化道造影异常。95例患者进行了动力研究，其中11例蠕动异常。所有手术均通过左胸切开术进行。
23例患者出现并发症，包括6例呼吸衰竭、3例心房颤动、3例肺不张、2例肺炎、2例心肌梗死、1例乳糜胸、1例严重吞咽困难、1例修复早期破裂、1例心脏压塞、1例血尿、1例脊柱性头痛以及1例扩张器术中穿孔。术后有2例死亡，均为心源性。住院时间中位数为8天（范围6至76天）。前25例患者有10例并发症（40%）和2例死亡（8%）。其余75例患者有13例并发症（17%）且无死亡（死亡率，p = 0.06；发病率，p = 0.03）。所有患者均完成随访，中位数为100个月（范围3至138个月）。98例手术幸存者中有86例目前仍存活。在最后一次随访时，58例患者（59%）功能结果极佳，24例（25%）良好，8例（8%）一般，7例（7%）较差，1例（1%）情况不明。
我们得出结论，未切断Collis-Nissen胃底折叠术在84%的患者中可提供良好至极佳的长期效果。手术死亡率和发病率可接受，但与学习曲线相关。
