腹腔镜下Nissen胃底折叠术治疗难治性胃食管反流病的短期疗效分析  

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

作　　者：王镇 张永强[2] 邵国益[1] 胡根[1] Wang Zhen;Zhang Yongqiang;Shao Guoyi;Hu Gen(Department of General Surgery,Jiangyin People's Hospital,Jiangyin 214400,China;Department of Gastroenterology,Jiangyin People's Hospital,Jiangyin 214400,Chian)

机构地区：[1]江阴市人民医院综合普外科,江阴214400 [2]江阴市人民医院消化内科,江阴214400

出　　处：《中国医师进修杂志》2024年第1期23-27,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨腹腔镜下Nissen胃底折叠术治疗难治性胃食管反流病(rGERD)的安全性和短期疗效。方法回顾性分析2018年3月至2022年3月江阴市人民医院61例行腹腔镜下Nissen胃底折叠术患者的临床资料。其中,术前服用质子泵抑制剂(PPI)后症状明显缓解14例(A组),服用PPI后症状部分缓解30例(B组),服用PPI后症状未缓解加用双倍剂量规律治疗8周以上症状仍未缓解17例(C组)。比较三组手术治疗和恢复情况。结果61例患者手术时间(117.46±28.50)min,术中失血量23.00(8.00,34.00)ml,术后住院时间3.00(2.00,5.00)d。三组手术时间、术中失血量、术后住院时间、合并食管裂孔疝手术、放置补片比较差异无统计学意义(P>0.05)。三组患者术后均未发生腹腔出血、腹腔感染和消化道穿孔等短期严重并发症。三组满意度评分、术后总体症状主观缓解、反流症状、PPI使用情况、吞咽困难、腹胀、腹泻或便秘比较差异无统计学意义(P>0.05)。三组均未发生上腹痛、复发和再手术情况。结论腹腔镜下Nissen胃底折叠术对于rGERD疗效确切,抗反流效果明显,术后未出现严重并发症,无复发和再手术病例。Objective To investigate the safety and short-term efficacy of laparoscopic Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease(rGERD).Methods The clinical data of 61 patients underwent laparoscopic Nissen fundoplication from March 2018 to March 2022 in Jiangyin People's Hospital were retrospectively analyzed.Among them,14 patients had significant symptom relief after using proton pump inhibitor(PPI)before operation(group A),30 patients had partial symptom relief after using PPI(group B),and 17 patients had persistent symptoms despite regular treatment with double-dose PPI for more than 8 weeks(group C).The surgical outcomes and recovery were compared among the three groups.Results For the 61 patients,the surgical time was(117.46±28.50)min,the intraoperative blood loss was 23.00(8.00,34.00)ml,and the postoperative hospital stay was 3.00(2.00,5.00)d.There were no statistically significant differences in surgical time,intraoperative blood loss,postoperative hospital stay,concurrent hiatal hernia repair and mesh placement among the three groups(P>0.05).No short-term severe complications such as abdominal bleeding,abdominal infection and gastrointestinal perforation occurred in any group.There were no statistical differences in satisfaction score,subjective relief of overall postoperative symptoms,reflux symptoms,PPI usage,dysphagia,abdominal distention,diarrhea or constipation among the three groups(P<0.05).No upper abdominal pain,recurrence and reoperation occurred in the three groups.Conclusions Laparoscopic Nissen fundoplication has a definite therapeutic effect on rGERD,with significant anti reflux effects.There are no serious complications after surgery,and there are no recurrence or reoperation.

关 键 词：胃食管反流 胃底折叠术 腹腔镜手术 质子泵抑制剂 治疗结果 

分 类 号：R571[医药卫生—消化系统]