腹腔镜高选择性迷走神经切断术联合Nissen胃底折叠术:效果如何?——腹腔镜Nissen迷走神经切断术治疗胃食管返流

Laparoscopic Highly Selective Vagotomy with Nissen Fundoplication, is There Any role? Laparoscopic Nissen Vagotomy for Reflux

背景：Nissen胃底折叠术（Nissen fundoplication，NF）已不是治疗胃食管返流性疾病（gastroesophageal reflux disease，GERD）的唯一、有效的方法。对于能降低胃酸的手术方式来讲，如高选择性迷走神经切断术（highly selective vagotomy，HSV），也不仅仅是一种辅助治疗方法。对高选择性迷走神经切断术联合Nissen胃底折叠术（Nissen fundoplication with highly selective vagotomy，NFHSV）治疗GERD的作用目前尚无完整的评价。方法：2003年6月～2005年6月8例女性病人接受NFHSV，8例均有6个月GERD病史，经药物治疗症状无缓解，有餐前痛、消化性溃疡或严重的胃炎。平均随访时间12个月，术前、术后进行烧心严重程度评分测定（heart burn severity score，HSS）。结果：平均手术时间110min，无手术并发症。1例术后须用质子泵抑制剂，术后经戒烟5个月后停药。8例术后症状和烧心严重程度评分测定有明显改善。结论：NFHSV是有效的联合手术方式，尚需要进一步的研究证实这一联合术式的完全有效性和安全性。

Introduction Nissen fundoplication （NF） hasn＇ t been a uniformly successful treatment for gastroesophageal reflux disease （GERD）. Acid lowering procedures such as highly selective vagotomy （HSV） have not yet been fully evaluated as an adjunctive treatment. NFHSV was evaluated in GERD. Materials and Methods Between June 2003 and June 2005,8 women with a history of 6 months of GERD unrelieved by medication, pre-prandial pain, peptic ulcer disease or severe gastritis underwent laparoscopic NFHSV. They have been followed for a mean 12 months. Pre- and post-operative Heart burn Severity scores （HSS） were obtained. Results Mean operative time was 110 minutes. There were no complications. One patient needed post-operative proton pump inhibitor, which was discontinued after smoking cessation 5 months after NFHSV. All 8 patients showed marked improvement in symptoms and HSS. Conclusion This series lends credence to the notion that NFHSV was effective. Several studies need to be performed to demonstrate the full efficacy and safety of this approach.