腹腔镜Nissen胃底折叠术与腹腔镜前180°部分胃底折叠术后5年临床效果的比较

Five-year efficacy of laparoscopic Nissen fundoplication versus anterior 180° partial fundoplication in the management of reflux esophagitis:A randomized controlled trial

目的:随机对照研究腹腔镜Nissen胃底折叠术及镜前180°部分胃底折叠术2种手术方式在术后5年的临床效果.方法:2006-03/12共有107例接受腹腔镜抗反流手术的患者随机分入腹腔镜Nissen胃底折叠术组和腹腔镜前180°部分胃底折叠术组,各组均采用标准手术操作.术后定期随访,对随访记录包括有无烧心反酸、吞咽困难、胀气症状、嗳气、是否排气过多等症状及手术满意度等进行主观评分.临床数据进行统计分析.结果:两组之间烧心症状以及服用质子泵抑制剂的比例没有显著性差异.出现吞咽困难的比例无明显差异,但是前胃底折叠术组患者吞咽困难的程度比Nissen组患者明显较轻.Nissen组的患者出现上腹胀气、无法有效嗳气及排气过多的比例较高.两组的总体临床效果满意度基本相同.术后5年大多数患者没有或只有轻微的反流症状.结论:腹腔镜前180°部分胃底折叠术抗反流效果持久,术后出现并发症及不良反应的比例明显低于Nissen胃底折叠术.腹腔镜前180°部分胃底折叠术可以作为临床治疗胃食管反流性疾病的常规手术方式.

AIM：To evaluate the long-term clinical outcome of laparoscopic Nissen fundoplication versus anterior 180° partial fundoplication in the management of reflux esophagitis.METHODS：One hundred and seven patients with reflux esophagitis were enrolled and randomly allocated into two groups to undergo laparoscopic Nissen fundoplication （Nissen group） and laparoscopic anterior 180° partial fundoplication （partial fundoplication group）.The patients were followed for 5 years after operation,and clinical data,such as the incidences of heartburn,dysphagia,bloating or flatulence,belching ability,and degree of satisfaction with the operation,were collected.RESULTS：There were no statistical significances between the two groups for the incidence of heartburn symptom and consumption of PPI.Though the incidence of dysphagia was similar between the two groups,the severity of the symptom in the partial fundoplication group was much lower than that in the Nissen group.There is a higher incidence of epigastric bloating,difficulty of belching and flatulence in the Nissen group.The degree of overall satisfaction with the operation was similar between the two groups.Most patients were free of reflux symptoms during the 5-year follow-up period.CONCLUSION：Laparoscopic anterior 180° partial fundoplication has good and durable antireflux effect and is associated with a lower incidence of post-operative complications compared to Nissen fundoplication,and can be employed as a routine procedure for treatment of gastroesophageal reflux disease.