腹腔镜Nissen胃底折叠联合His角重建术治疗胃食管反流病的短期疗效

Short-term efficacy of laparoscopic Nissen fundoplication combined with the reconstruction of His angle in the treatment of gastroesophageal reflux disease

目的探讨腹腔镜Nissen胃底折叠术联合His角重建治疗胃食管反流病(GERD)的效果。方法回顾性分析2018年10月至2021年2月于首都医科大学宣武医院普通外科接受Nissen胃底折叠(360°)+His角重建术和单纯Nissen胃底折叠术GERD患者的临床资料,观察比较两种术式抗反流效果的差异、患者对手术治疗满意度等情况。结果本研究共纳入GERD患者98例,其中Nissen+His角重建组为52例,Nissen组为46例。术后6个月时,2组患者GERD相关症状(食管症状:反流、胃灼热、胸背痛及剑突下顶胀感。食管外症状:咳嗽、喘息、咽部异物感)评分均显著低于治疗前(P<0.05)。术后症状评分中,Nissen+His角重建组反流、胃灼热症状评分低于Nissen组,差异有统计学意义(反流:Z=-2.466,P=0.014;胃灼热:Z=-2.674,P=0.007);2组其他症状评分差异均无统计学意义(P>0.05)。2组术后功能性并发症(包括吞咽困难、腹胀、难以嗳气、排气增多及慢性腹部疼痛)发生率相似,经保守治疗均获得明显缓解。Nissen+His角重建组患者对手术治疗满意度为94.2%(49/52),Nissen组患者满意度为91.3%(42/46),2组患者手术满意度差异无统计学意义(P=0.866)。结论Nissen胃底折叠+His角重建术与Nissen胃底折叠术均有较好的抗反流疗效,手术并发症少、轻微,患者满意度高。与Nissen组相比,Nissen+His角重建组控制反流、胃灼热症状更佳,该结果需要前瞻性、大样本、长期随访结果予以证实。

Objective To investigate the efficacy of Nissen fundoplication combined with the reconstruction of His angle for gastroesophageal reflux disease(GERD).Methods The clinical data of GERD patients who received Nissen fundoplication combined with His angle reconstruction or Nissen fundoplication alone in the department of general surgery of Xuanwu Hospital of Capital Medical University from October 2018 to February 2021 were retrospectively analyzed.The differences of the anti-reflux effects and the satisfaction of the two procedures were observed and compared.Results 98 GERD patients were included in this study,including 52 patients in the Nissen+His angle reconstruction group and 46 patients in the Nissen group.6 months after operation,GERD related symptoms(esophageal symptoms:reflux,heart burn,chest and back pain,and distension in the lower of xiphoid;extraesophageal symptoms:cough,wheezing,foreign body sensation of pharynx)scores were significantly lower than those before treatment(allP<0.05).In postoperative symptoms scores,score of the reflux and heart burn symptom of the Nissen+His angle reconstruction group were lower than that of Nissen group,the difference was statistically significant(reflux:Z=-2.466,P=0.014;heart burn:Z=-2.674,P=0.007).There was no statistical difference in the scores of other symptom between the two groups(allP>0.05).Postoperative functional complications(including dysphagia,abdominal distention,difficult belching,increased exhaust and chronic abdominal pain)were similar in both groups,and were significantly relieved after conservative treatment.The satisfaction of the group of Nissen+His angle reconstruction and the group of Nissen was 94.2%(49/52)and 91.3%(42/46),respectively,and no significant difference was observed(P=0.866).Conclusion Both Nissen+His angle reconstruction and Nissen fundoplication alone had good anti-reflux efficacy,with few and mild surgical complications and high patient satisfaction.Compared to Nissen group,Nissen+His angle reconstruction group had better control of reflux and heart burn symptoms,which required prospective,large-sample,and long-term follow-up results to confirm.