腹腔镜Nissen与Toupet胃底折叠术治疗难治性胃食管反流病的效果比较  

Comparison of effects of laparoscopic Nissen versus Toupet fundoplication in the treatment of refractory gastroesophageal reflux disease

作　　者：于爱萍[1] 董新华[1] 李珂[1] 杨柳[1] 金子琛 Yu Aiping;Dong Xinhua;Li Ke;Yang Liu;Jin Zichen(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院,450052

出　　处：《中国实用医刊》2021年第22期1-4,共4页Chinese Journal of Practical Medicine

摘　　要：目的比较腹腔镜Nissen与Toupet胃底折叠术治疗难治性胃食管反流病的临床效果。方法回顾性选取2018年1月至2019年12月在郑州大学第一附属医院行腹腔镜胃底折叠术治疗的132例难治性胃食管反流病患者作为研究对象,将其中行腹腔镜Nissen胃底折叠术的68例患者作为Nissen组,将行腹腔镜Toupet胃底折叠术的64例患者作为Toupet组。比较两组患者围术期指标,术前和术后1个月高分辨率食管测压结果[食管下括约肌静息压(LESP)、食管下括约肌完整松弛压(IRP)]、食管24 h pH监测结果(DeMeester评分、反流次数)、GERD-Q评分结果,术后临床症状改善情况,术后住院期间和术后1年并发症发生情况。结果Nissen组患者的手术时间短于Toupet组(P<0.05)。两组术后1个月LESP、IRP均高于术前(P均<0.05),DeMeester评分、反流次数和GERD-Q评分均低于术前(P均<0.05),但两组之间比较,差异均无统计学意义(P均>0.05)。两组术后1个月患者的灼烧感、反酸、反食、胸痛评分均低于术前(P均<0.05),但两组之间比较,差异均无统计学意义(P均>0.05)。住院期间,Nissen组吞咽困难发生率高于Toupet组(P<0.05);术后1年,Nissen组吞咽困难发生率与Toupet组比较,差异无统计学意义(P>0.05)。结论腹腔镜Toupet和Nissen胃底折叠术治疗难治性胃食管反流病均有较好疗效。与腹腔镜Toupet胃底折叠术比较,腹腔镜Nissen胃底折叠术手术时间较短,术后近期吞咽困难发生率较高,远期吞咽困难的发生率相当。Objective To compare the clinical efficacy of laparoscopic Nissen and Toupet fundoplication in the treatment of refractory gastroesophageal reflux disease.Methods 132 patients with refractory gastroesophageal reflux disease treated by laparoscopic fundoplication in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2019 were collected retrospectively.Sixty-eight patients undergoing laparoscopic Nissen fundoplication were selected as Nissen group,and 64 patients undergoing laparoscopic Toupet fundoplication were selected as Toupet group.The operation-related indexes,the results of high-resolution esophageal pressure measurement[lower esophageal sphincter pressure(LESP),Integrated relaxation pressure(IRP)],the results of 24-hour pH monitoring[DeMeester score,the number of reflux],GERD-Q score before and after 1 month of operation,the improvement of clinical symptoms after operation,and complications during postoperative hospitalization and 1 year afteroperation were compared between two groups.Results The operation time of the Nissen group was shorter than that of the Toupet group(P<0.05).Compared with before operation,the LESP and IRP of the two group were higher than those after 1 month of operation(all P<0.05);the DeMeester score,the number of reflux and the GERD-Q score were lower than those after 1 month of operation(all P<0.05);while there was no statistical difference between the two group(all P>0.05).Compared with before operation,the scores of burning sensation,acid reflux,regurgitation,and chest pain of Nissen group and Toupet group were lower than those after 1 month of operation(all P<0.05);while there was no statistical difference between the two group(all P>0.05).During hospitalization,the incidence of dysphagia in the Nissen group was higher than that in the Toupet group(P<0.05),After 1 year of operation,there was no difference between the two groups(P>0.05).Conclusions Laparoscopic Toupet and Nissen fundoplication have good curative effects in the treatment of refrac

关 键 词：胃 食管 反流病 腹腔镜 胃底折叠术 

分 类 号：R57[医药卫生—消化系统]