食管测压在Nissen胃底折叠术中的应用

Outcome of Nissen fundoplication using intraoperative manometry

目的通过 Nissen 胃底折叠术中监测食管下括约肌压力(LESP)、食管下括约肌总长度(LESL)的变化,判断胃底折叠缝合的松紧程度,改进 Nissen 胃底折叠术抗反流的治疗效果。方法84例经腹手术治疗滑动型食管裂孔疝患者,根据手术方式分成3组:典型 Nissen 手术组27例,短松式 Nissen 手术组39例,短松式 Nissen 加术中测压组(测压组)18例。对患者术前、术中及术后 LESP和 LESL、术后并发症、手术远期疗效等进行观察记录。结果全组无术中死亡。术后1个月内典型Nissen 手术组患者吞咽困难2例,反酸1例,短松式 Nissen 手术组反酸2例,测压组无术后吞咽困难或反酸。72例术后随访。典型 Nissen 手术组中2例有明显吞咽困难,1例恶心、呕吐;短松式 Nissen手术组中1例复发;测压组仅1例24 h pH 监测有明显酸反流,但无症状。结论经腹的典型 Nissen手术、短松式 Nissen 手术治疗食管裂孔疝可取得较为理想的效果,但通过抗反流手术加术中测压,能够更准确判断胃底折叠缝合的松紧程度,有利于避免或减少术后并发症。

Objective Through reviewing the surgical experience in the treatment of sliding hiatus hernia, the effectiveness of Nissen fundoplication using intraoperative oesophageal manometry has been evaluated. Methods There were 84 undergoing the transabclominal surgery who have been divided into three groups ： 27 patients were in the Nissen group, 39 in the floppy Nissen group, 18 in the intraoperative-oesophageal-manometry group. Results There is no postoperative death. Complications occurred in 5 patients within one month after operation：in the Nissen group, 2 patients suffered from severe dysphagia and 1 from regurgitation; In the floppy Nissen group, 2 patients had regurgitation; In the intraoperative- oesophageal-manometry group, there were no one suffering severe dysphagia or regurgitation. During the long-term follow-up, excellent functional results were also observed in the intraoperative-oesophageal-manometry group, whereas 2 patients suffered from severe dysphagia and 1 from nausea in the Nissen group and 1 patient recurred in the floppy Nissen group. Conclusions The Nissen fundoplication （NF） should be suitable to be clone in patients with sliding hiatus hernia. But if there are possibilities to perform intraoperative oesophageal manometry during the operation of anti-reflux, side effects can be decreased to the least. Intraoperative manometry is useful in standardizing the tightness of the wrap in NF. And it will contribute to reducing or avoiding the happening of complications.