腹腔镜Toupet和Nissen胃底折叠术治疗难治性胃食管反流病的疗效对比

Comparative study on the effects of laparoscopic Toupet versus Niseen fundoplication for refractory gastroesophageal reflux disease

目的 对比腹腔镜Toupet和Nissen胃底折叠术治疗难治性胃食管反流病(rGERD)的临床疗效。方法回顾性分析2014年12月至2019年1月陆军军医大学第三附属医院胸外科收治的74例进行腹腔镜胃底折叠术的rGERD患者的临床资料。其中44例患者行Toupet胃底折叠术(Toupet组),30例患者行Nissen胃底折叠术(Nissen组)。比较2组患者术前与术后高分辨率食管测压、24h监测pH、GERD-Q量表评分及围术期恢复情况。结果2组患者均无死亡及重大并发症,术后患者反流症状较术前均明显缓解,差异有统计学意义(P<0.05)。2组患者术后DeMeester评分、食管下括约肌压力(LESP)、完整松弛压力(IRP)、食管远端收缩积分平均值(DCI)、总反流次数、GERD-Q量表评分较术前均明显改善,差异有统计学意义(P<0.05)。2组患者手术时间、术中出血量、术后禁食时间、住院时间比较差异无统计学意义(P>0.05);Toupet组术后出现吞咽困难2例(4.5%),Nissen组出现吞咽困难7例(23.3%),2组比较差异有统计学意义(P<0.05)。结论腹腔镜Toupet和Nissen胃底折叠术都是治疗rGERD安全有效的手术方式,但Toupet术式术后吞咽困难发生率低于Nissen术式。

Objective To investigate the clinical efficacy and postoperative outcomes of laparoscopic Toupet and Nissen fundoplication in treatment of refractory gastroesophageal reflux disease(rGERD).Methods The clinical data of 74 patients with rGERD who underwent laparoscopic Toupet(Toupet group,44 cases)and Nissen fundoplication(Nissen group,30 cases)in our department from December 2014 to January 2019 were retrospectively analyzed.Preoperative and postoperative esophageal high-resolution manometry,24-hour pH monitoring,as well as GERD-Q questionnaire of the two groups were evaluated.Results No incidence of death and severe complication happened,and the reflux symptom were significantly relieved in both of the two groups(P<0.05).The DeMeester score,lower esophageal sphincter pressure(LESP),integrated relaxation pressure(IRP),distal contractile integral(DCI),reflux frequency and GERD-Q scores were significantly improved in both of the two groups(P<0.05).There was no significant difference in operative duration,intraoperative blood loss,postoperative hospital stay and fasting duration of the two groups(P>0.05).A higher frequency of dysphagia was present in the Nissen group(7 cases,23.3%)compared with the Toupet group(2 cases,4.5%),and the difference between the two groups was statistically significant(P<0.05).Conclusion Both laparoscopic Toupet and Nissen fundoplication are safe and effective in treatment of rGERD,but laparoscopic Toupet has a lower incidence of postoperative dysphagia compared with Nissen fundoplication.