改良Nissen胃底折叠术治疗胃食管反流病的短期疗效分析  

Short-term efficacy analysis of laparoscopic modified Nissen fundoplication for gastroesophageal reflux disease

作　　者：高颖 杜兴[1] 罗颖 刘殿刚[1] GAO Ying;DU Xing;LUO Ying(Department of General Surgery,Xuanwu Hospital Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院普通外科,北京100053

出　　处：《腹腔镜外科杂志》2023年第1期34-40,共7页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜改良Nissen胃底折叠术治疗胃食管反流病的短期疗效。方法:回顾分析2020年6月至2021年11月接受腹腔镜改良Nissen胃底折叠术的81例患者的临床资料,比较术前、术后反流症状及术后并发症的7级李克特量表评分,统计质子泵抑制剂药物的服用情况及对手术的满意程度。结果:患者术后胃食管反流病相关症状的评分均低于治疗前(P<0.05);术后大部分患者出现不同程度的吞咽困难,其中症状不可忽略的吞咽流食困难比例为6.2%,症状不可忽略的吞咽固体困难比例为63%;术后新发腹胀、便秘与腹泻的比例分别为37%、18.5%与11.1%,均为自限性;术后DeMeester评分、酸反流时间百分比及反流总次数均较术前有所改善,术后食管下括约肌压力、食管下括约肌长度及食管下括约肌腹段长度较术前增加;术后6个月体重下降(3.8±3.27)kg(P<0.05),术后6个月身体质量指数下降(1.4±1.31)kg/m^(2)(P<0.05),不同身体质量指数分组间身体质量指数变化值与体重变化值的分布不完全相同;术后6个月质子泵抑制剂停药率为96.3%,疗效满意率为96.2%,无复发与再手术病例。结论:改良Nissen胃底折叠术可改善胃食管反流病的症状,无严重手术并发症、复发及再手术病例,安全、可行。Objective:To investigate the short-term efficacy of laparoscopic modified Nissen fundoplication in the treatment of gastroesophageal reflux disease(GERD).Methods:The clinical data of 81 patients who underwent laparoscopic modified Nissen fundoplication from Jun.2020 to Nov.2021 were retrospectively analyzed.The 7-level Likert scale scores of preoperative and postoperative reflux symptoms and postoperative complications were compared.The use of proton pump inhibitor and the degree of satisfaction with the operation were analyzed.Results:The scores of GERD-related symptoms after the operation were significantly lower than those before operation(P<0.05).Most of the patients had different degrees of dysphagia after the operation.The proportion of liquid dysphagia with non-negligible symptoms was 6.2%,the proportion of solid dysphagia with non-negligible symptoms was 63%.The incidence of postoperative new abdominal distension,constipation and diarrhea was 37%,18.5%and 11.1%.All the above postoperative symptoms were self-limiting.The DeMeester score,the percentage of acid exposure time and total number of regurgitations were improved after the operation.The pressure of lower esophageal sphincter(LES),the length of LES and the abdominal segment length of LES increased after the operation.The weight decreased by(3.8±3.27)kg(P<0.05),and body mass index(BMI)decreased by(1.4±1.31)kg/m^(2) in 6 months after the operation(P<0.05).The distribution of BMI change and weight change was not all the same among different BMI groups.The rate of proton pump inhibitor discontinuation was 96.3%and the satisfaction rate was 96.2%at 6 months after the operation.There were no recurrence or reoperation cases.Conclusions:Laparoscopic modified Nissen fundoplication is safe and feasible,can relieve the symptoms of GERD patients without serious postoperative complications,recurrence and reoperation.

关 键 词：胃食管反流 NISSEN胃底折叠术 腹腔镜检查 改良术式 治疗结果 

分 类 号：R656.6[医药卫生—外科学]