腹腔镜Nissen与Toupet胃底折叠术治疗胃食管反流性疾病的临床分析  

Laparoscopic Nissen Fundoplication versus Laparoscopic Toupet Fundoplication for gastro-esophageal reflux disease

作　　者：杨慧琪[1] 秦明放[1] 

机构地区：[1]天津市南开医院,天津300100

出　　处：《中国实用外科杂志》2006年第9期673-675,共3页Chinese Journal of Practical Surgery

摘　　要：目的比较腹腔镜Nissen与Toupet胃底折叠术治疗胃食管反流性疾病(GERD)的优缺点及其适应证。方法回顾分析2001年6月至2005年12月腹腔镜胃底折叠术后GERD的83例临床资料。其中65例行腹腔镜Nissen胃底折叠术,18例行腹腔镜Toupet胃底折叠术。结果两组均无中转开腹及死亡病例。术后两组症状均完全消失。平均随访2.6年,Nissen组未出现症状复发,Toupet组2例病人症状复发,需服抑酸药物控制。术后4个月复查食道测压和酸反流的指标两组均在正常范围内。Nissen组食道炎症的治愈率为84.6%,Toupet组为66.7%。术后4d,Nissen组吞咽困难、腹胀的发生率明显高于Toupet组(分别为27.7%和16.7%);术后1年,两组之间的差别明显减小(分别为1.5%和0)。结论Toupet胃底折叠术后短期内呑咽困难的发生率明显低于Nissen胃底折叠术,但随着术后恢复时间的延长,两者间差异明显减小。对中重度GERD应首选腹腔镜Nissen胃底折叠术,对高龄,术前检查提示食管蠕动功能明显减弱的病人,可考虑行腹腔镜Toupet胃底折叠术。Objective Compare the operative results and incidence of dysphagia between the Nissen fundoplication and Toupet fundoplication. Methods Retrospectively eighty-threecases of Laparoscopic Fundoplication were reviewed from June eighty-three cases of Laparoscopic Fundoplication we 2001 to December 2005. Laparoscopic Nissen Fundoplication was performed in 65, Laparoscopic Toupet Fundoplication was performed in 18. Results There was no conversion and death. The symptoms disappeared completely and was no recurrence in Nissen fundoplication while two cases of recurrence in Toupet fundoplication during the period of follow up. In Nissen fundoplication, the healing rate of esophagitis was 84. 6% while 66. 7% in the other. The incidence of dysphagia and abdominal distension was higher in Nissen fundoplication than in Toupet fundoplication （27.7% versus 16.7% ） 4 days after operation. The difference decreased significantly 1 year after operation. Conclusion Toupet fundoplication has a lower incidence of dysphagia than Nissen fundoplication early after operation. But the difference decreased significantly 1 year after operation. Nissen fundoplication is the first choice in treatment of severe gastro-esophageal reflux disease. Toupet fundoplication can be performed in patients with preoperative esophageal hypomotility.

关 键 词：NISSEN胃底折叠术 Toupet胃底折叠术 胃食管反流性疾病 

分 类 号：R6[医药卫生—外科学]