Nissen胃底折叠术与前180度胃底折叠术的疗效比较  

Efficacy of laparoscopic Nissen fundoplication versus anterior 180° fundoplication in the treatment of gastroesophageal reflux disease

作　　者：曹占国[1] 秦鸣放[2] 王庆[2] 赵宏志[2] 

机构地区：[1]天津医科大学研究生院,天津市300193 [2]天津南开医院,天津市300100

出　　处：《世界华人消化杂志》2010年第24期2594-2598,共5页World Chinese Journal of Digestology

摘　　要：目的:比较前180度折叠术与360度Nissen胃底折叠术的两年临床效果及术后并发症发生率.方法:2004-06/2008-05共409例重度胃食管反流疾病患者接受了腹腔镜前180度或Nissen胃底折叠术.对两组患者两年随访结果进行比较分析.结果:共253例患者接受了Nissen胃底折叠术(N组),156例患者接受了180度前折叠术(A组).N组和A组各有83例患者(47例腹胀和36例吞咽困难)和26例患者(16例腹胀和10例吞咽困难)出现术后胃肠功能障碍(P<0.05).术后平均随访46.3±6.5(24-92)mo.两组病例在术后两年生活质量评分、食管炎及24hpH监测无显著差异.结论:两种折叠术式对改善大多数胃食管反流病患者生活质量,控制反流的效果相当,但前180度折叠较Nissen折叠对胃肠功能影响更小.AIM： To compare the efficacy and safety of laparoscopic Nissen fundoplication versus anterior 180 o fundoplication in patients with gastroesophageal reflux disease （GERD）.METHODS： A total of 409 patients with severe GERD who underwent laparoscopic Nissen fundoplication （group N,n = 253） or anterior 180 o fundoplication （group A,n = 156） from June 2004 to May 2008 were included in the study.The preand post-operative gastrointestinal quality of life index （GIALI） was assessed in all the patients.RESULTS： Approximately 76.1% （311/409） of patients had a lower esophageal sphincter （LES） pressure less than 15 mmHg.The mean operation time was significantly longer in group N than in group A （116 min ± 8 min vs 96 min ± 5 min,P 0.05）.The mean duration of postopera-tive hospitalization was 3.6 d in group N and 3.4 d in group A.Postoperative complications occurred in 3 patients in group N and in 2 patients in group A,and no death occurred.There were 33 patients with postoperative abdominal bloating and 24 patients with postoperative dysphagia in group N,and the corresponding figures in group A were 16 and 14,respectively.The mean duration of follow-up was 46.3 mo ± 6.5 mo （57.2 mo ± 7.3 mo in group N vs 27.6 mo ± 4.2 mo in group A）.No statistical differences were noted in life quality score and the results of esophageal manometry and ambulatory 24-h pH monitoring at 2 years of follow-up between the two groups.CONCLUSION： Both laparoscopic Nissen fundoplication and anterior 180 o fundoplication are effective for GERD.Anterior 180 o fundoplication is associated with less postoperative adverse effects compared with Nissen fundoplication.

关 键 词：胃食管反流病 腹腔镜NISSEN胃底折叠术 前180度胃底折叠术 

分 类 号：R656.61[医药卫生—外科学]