腹腔镜Nissen与Toupet胃底折叠术式治疗胃食管反流病疗效比较的Meta分析

Meta-analysis of laparoscopic Nissen and Toupet fundoplication for gastro-oesophageal refluxdisease

目的比较腹腔镜Nissen手术与Toupet手术在治疗胃食管反流病的疗效以及术后并发症的发生率。方法通过Pubmed，Medline，Embase以及Cochrane图书馆数据库进行文献检索，用Nissen，Toupet，fundoplication[Mesh]为关键词，仅将比较腹腔镜Nissen以及Toupet两种手术方式的随机对照研究纳入本研究，分别统计两组患者在术后早期（3-6个月）以及术后晚期（1。3年）的烧心、反酸、吞咽困难、胸痛、腹胀、不能打嗝、腹泻、术后早期并发症的发生率及满意度等。结果在纳入本研究的7个随机对照研究总计939例患者中．腹腔镜Nissen手术478例，腹腔镜Toupet手术461例。两组患者的反流症状均得到了良好的控制．术后烧心的发生率差异无统计学意义（DR：1．01，95％CI：0．48。2．13，P=0．97）。尽管Toupet组在术后早期及晚期吞咽困难的发生率显著低于Nissen组（OR=3．34，95％CI：2．22-5．02，P〈0．01），但前者术后早期并发症的发生率显著高于后者（OR=O．31，95％CI：0．11-0．93，P=0．04）；而两组患者术后远期满意度差异无统计学意义（OR=0．98，95％CI：0．61-1．56。P=0．92）。结论腹腔镜Nissen及Toupet手术均为安全有效的手术方式。选择哪种术式可根据患者情况及外科医生自身技术和经验而定。

Objective To compare laparoscopic Nissen fundoplication （LNF）and Toupet laparoscopic fundoplication （LTF）with respect to treatment outcomes and postoperative complications. Methods PubMed, Medline, Embase and the Cochrane Library were searched. Only randomized controlled trials （RCTs） comparing laparoscopic Nissen and Toupet fundoplication were included. Outcomes evaluation included occurrences of heartburn, reflux, difficulty swallowing, chest pain, abdominal distention, failure to hiccup, diarrhea, and early complications and degree of patient satisfaction at early （three to six months） and later （one to three years） post-operative periods. Results Of 939 patients in seven RCTs, 478 received LNF and 461 received LTF. For both groups, control of reflux was good and occurrence of heartburn was similar （P〉0.05）. A lower incidence of postoperative dysphagia for both early and later post-operative periods, but a higher overall complication rate in early post-operative period were observed in the LTF group （P〈0.05）. Patient satisfaction was similar （P〉 0.05）. Conclusions LNF and LTF are both safe and effective. The adoption of procedure should be based on the patient status and surgeon experience.