胃食管反流病的腹腔镜手术治疗

Laparoscopic treatment for gastroesophageal reflux disease

目的探讨腹腔镜胃底折叠术治疗胃食管反流病的临床效果。方法分析2008年1月至2014年6月，新疆医科大学第一附属医院收治的82例胃食管反流病行腹腔镜胃底折叠术患者的临床资料。9例行腹腔镜单纯胃底折叠术（ Toupet式），腹腔镜食管裂孔疝修补加胃底折叠术73例（ Nissen式9例，Toupet式64例）。结果手术均获成功，手术时间75～240 min、平均92 min，术中出血量5～200 ml ，平均14 ml ，均无输血。无术中中转开腹，无术后严重并发症，无死亡。腹腔引流管拔除时间1～3 d，平均2 d，术后住院时间4～10 d，平均7 d。82例术后随访1～24个月，平均15个月，64例临床症状完全消失，17例症状明显好转，1例无效。结论腹腔镜胃底折叠术是治疗胃食管反流病的有效方法，具有安全、有效、创伤小、患者恢复快和操作安全的优点，临床疗效满意。

Objective To explore the clinical effect of laparoscopic fundoplication in the treatment of gastroesophageal reflux disease （ GERD ） .Methods Clinical data of patients with GERD in The First Affiliated Hospital of Xinjiang Medical University by laparoscopy was analyzed from January 2008 to June 2014.Among the patients,simple Toupt fundoplication was carried out in 9 cases,fundoplication combined with laparoscopic hiatal herniorraphy was performed on the other 73 cases （ Nissen in 9 and Toupet in 64 ） . Results All the patients had successfully completed operation , the operation time ranged from 75-240 minutes,with an average 92 minutes,the intraoperative blood loss was 5-200 ml,average was 14 ml,there was no blood transfusion ,no conversion to open surgery ,no severe postoperative complications and death .The time of drainage tube pulled out were 1-3 days,with average 2 days,postoperative hospitalization was 4-10 days, with average 7 days.82 patients were followed up for 1-24 months,with average 15 months,clinical symptoms disappeared completely in 64 cases and improved significantly in 17 cases, 1 case was invalid. Conclusion Laparoscopic fundoplication is effective in GERD and has the advantage of short hospital stay , good cosmetic result ,fast recovery and less complication .