胃食管反流病外科治疗术式的演变和展望  

The evolution and expectation of surgical options for gastroesophageal reflux disease

作　　者：吴继敏 陈冬 Wu Jimin;Chen Dong(Department of Gastroesophageal Surgery,People′s Liberation Army Rocket Force Characteristic Medical Center,Beijing 100088,China)

机构地区：[1]火箭军特色医学中心胃食管外科,北京100088

出　　处：《中华外科杂志》2020年第9期677-682,共6页Chinese Journal of Surgery

摘　　要：胃食管反流病的外科手术治疗在国外已开展近70年,在我国尚处于起步阶段。Allison于1951年最早尝试使用外科手段控制反流,但单纯性的食管裂孔修补疗效欠佳。Nissen于1955年开创胃底折叠术,经Rossetti改良减少了游离范围和手术损伤,提升了抗反流疗效,但术后吞咽困难和气体相关并发症高发。Toupet、Dor等提出部分胃底折叠术,Donahue和DeMeester提出"短松"Nissen手术,在一定程度上保留了手术疗效并降低了术后吞咽困难和气体相关并发症发生率,形成了目前三大主流胃底折叠术式。此外,其他医师也对抗反流术式进行了探索,形成了Belsey MarkⅣ、Hill、Collis等术式,但由于种种原因上述术式未获得广泛开展。与此同时,手术途径也从传统的开胸开腹,发展到腹腔镜及机器人手术系统辅助,降低了并发症发生率,减少了住院时间。尽管抗反流术式众多,但各种术式各有优缺点,长期疗效不稳定及各种并发症至今仍然是其获得广泛开展的主要障碍,人们仍然在不断探索更好更微创的抗反流手术方法。It has been nearly 70 years since the first attempt of surgical treatment for gastroesophageal reflux disease in Western countries,while in China,it is still in initial stage.Allison first attempted to control gastroesophageal reflux through surgical approach in 1951,but single hiatal hernia repair was inadequate to control reflux.Nissen developed fundoplication in 1955,and Rossetti modified it for reduction of the mobilized extent and related damage.The anti-reflux effect has been greatly improved but with high incidence of dysphagia and gas related complications.In order to solve these troublesome symptoms,Toupet and Dor came up with partial fundoplication,DeMeester and Donahue came up with"short floppy"Nissen fundoplication,they all successfully reduced the incidence of dysphagia and gas related complications but with preservation of anti-reflux effect.Thereafter,the three main stream fundoplication was formed(short floppy Nissen,Toupet and Dor procedures).In addition,other attempts for surgical control of gastroesophageal reflux were made,such as Belsey MarkⅣ,Hill and Collis procedures,but they are not as popular as fundoplication for a variety of reasons.In the meantime,the operative approach was converted from traditional laparotomy and thoracotomy to laparoscopic or robot-assisted laparoscopic era,and the anti-reflux effect was preserved with reduction in the duration of hospital stay and incidence of complications.Although plenty of anti-reflux procedures exists,they all with their own advantages and disadvantages,the concern for inadequate long-term anti-reflux effect and post-operative complications remains the main obstacle to the widespread of anti-reflux surgery.Better and more minimally invasive anti-reflux treatments should be explored.

关 键 词：胃食管反流 胃底折叠术 腹腔镜检查 

分 类 号：R655.4[医药卫生—外科学]