腹腔镜胃底前180°折叠术治疗胃食管反流病疗效分析

Analysis on curative effect of laparoscopic 180° anterior fundoplication for gastroesophageal refulx disease

目的：探讨腹腔镜胃底180＆#176;折叠术治疗胃食管反流性疾病的可行性和安全性。方法2005年9月至2014年12月采用腹腔镜180＆#176;前胃底折叠术治疗胃食管反流性疾病114例,术后随访6~25个月,对酸反流的主观和客观指标进行分析。结果手术平均时间为54．3（45~90）min；术中平均出血量18（5~50）ml,无术中或术后输血者。术后24~48 h全流饮食。术后住院2~8 d,平均3．25 d。食管下括约肌腹腔内部分长度、食管下括约肌基底平均压力、食管下括约肌残余压力平均值、24 h pH监测DeMeester评分等指标较术前明显改善。食管下括约肌长度、食管下括约松弛率、食管体部蠕动平均波幅、远端收缩积分平均值、远端收缩积分最高值、收缩前沿速度、食管内部压力、食团内压平均最大值较术前无明显变化。结论腹腔镜胃底180＆#176;折叠术治疗胃食管反流性疾病是一种安全、有效的术式。

Objective To investigate the feasibility and safety of laparoscopic fundoplication 180＆#176; folding treatment for gastroesophageal reflux disease. Methods Laparoscopic 180＆#176; of gastric fundus folding operation was applied in the treatment of gastric esophageal reflux disease in 114 cases,patients were followed up from 6 to 25 months,the subjective and objective indicators of acid reflux were analyzed from September 2005 to December 2014. Results The average time of operation was 54. 3（45 to 90）minutes;the average intraoperative blood loss was 18（5 to 50） ml,there was no intraoperative or postoperative blood transfusion. Full flow diet was adopted in 24 to 48 h after operation. The postoperative hospital stay was 2 to 8 days, average was 3. 25 days. The length of the lower esophageal sphincter in the peritoneal cavity,average pressure of lower esophageal sphincter basal, residual pressure of lower esophageal sphincter, 24 h pH monitoring demeester score index significantly improved compared with preoperation. The length of the abdominal cavity of the lower esophageal sphincter, esophageal sphincter relaxation rate, esophageal body peristalsis average amplitude, distal integral average, distal contraction integral peak, contraction frontier speed, esophageal internal pressure, food group mean pressure maximum had no significant change compared with the preoperation. Conclusion Laparoscopic 180＆#176; anterior fundoplication for gastroesophageal refulx disease is a safe,effective operation.