经腹腔镜Nissen与Toupet胃底折叠术治疗GERD前瞻性随机对照研究的Meta分析  

Meta-analysis of prospective randomized controlled trials comparing the efficacy of laparoscopic Nissen and Toupet Fundoplication in GERD therapy

作　　者：卡哈尔.吐尔孙 艾克拜尔.艾力 麦麦提艾力.麦麦提明 买买提吐尔逊.吐尔迪 克力木.阿不都热依木 

机构地区：[1]新疆医科大学研究生学院,乌鲁木齐830000 [2]喀什地区第一人民医院普外二科,喀什844000 [3]新疆自治区人民医院GERD研究中心 [4]新疆自治区人民医院微创疝和腹壁外科,乌鲁木齐830000

出　　处：《中华胃食管反流病电子杂志》2016年第2期72-80,共9页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

摘　　要：目的系统评价腹腔镜Nissen胃底折叠术（LNF）与腹腔镜Toupet胃底折叠术（LTF）治疗胃食管反流疾病（gastroesophageal reflux disease,GERD）的价值和意义。方法计算机检索Cochrane图书馆（2015年第二期）;PubMed（1978~2016）;Embase（1966.1~2016.5）;CMB（1978.1~2016.5）;VIP（1989.1~2016.5）;CNKI（1989.1~2016.5）;OVID（2006~2016.5）。查阅文章后所附的参考文献及手工检索相关杂志及会议论文集中未发表的文献。结果纳入10个随机对照试验,共1 468例患者,试验组（INF）769例,对照组（LTF）701例。结果显示LNF与LTF治疗GERD的疗效,手术时间差异无统计学意义（P=0.09）;术后6个月和1年吞咽困难、胃灼热、腹胀、胸痛发生率差异无统计学意义（P〉0.05）。术后DeMeester评分差异有统计学意义（P=0.007）;术后6个月和2年食管反流发生率差异无统计学意义（P=0.77）。结论现有有限证据表明如果把握好手术适应症,运用LNF较ITF治疗GERD并不缩短手术时间,术后6个月、1年吞咽困难、胃灼热、腹胀、胸痛发生率和2年食管反流病的复发率无明显差异。术后DeMeester评分INF组明显低于LTF组,但反流症状无明显差异。Objective To evaluate the value and significance of laparoscopicnissen fundoplication（LNF） and laparoscopictoupetfundoplication（LTF） in thetreatment of gastroesophageal reflux disease（GERD）.Methods This paper searched the Cochrane library（issue 2,2015）;PubMed（1978 to 2016）;Embase（1966.1 to 2016.5）;CMB（1978.1 to 2016.5）;VIP（1989.1 to 2016.5）;CNKI（1989.1 to2016.5）;OVID（2006 to 2016.5） as well as hand searched several related journals and conference proceedings for the randomized controlled trials involving the comparison of the efficacy of the LNF versus LTF in patients with GERD.Results 10 studies involving 1 468 patients were identified studies（LNF：769,LTF：701）.When comparing LNF with LTF for thetreatment of GERD,LNF versus LTF showed no statistical difference in operation time（P=0.09）.No statistical difference in 6-month and 1-year postoperative dysphagia,heartburn,abdominal distention,and thoracrodynia（P〉0.05）.It showed astatistical difference in postoperative DeMeester score（P = 0.007）.There was no statistical difference in 6-month and 2-year postoperative regurgitation（P = 0.77）.Conclusion The limited evidence suggested that if indications of surgery were graspedwell,the operation time was not shortenedby using LNF compared with LTF for the treatment of GERD.There was no significant difference after LNF or LTF in 6-month or 1-yearincidence of dysphagia,heartburn,abdominal distention,thoracodynia,and 2-year incidence of GERD recurrence rate.DeMeester score was significantly lower than that of LTF patients,but there was no significant difference in reflux symptoms.

关 键 词：胃底折叠术 胃食管反流 荟萃分析 NISSEN TOUPET 

分 类 号：R656.6[医药卫生—外科学]