腹腔镜Nissen胃底折叠术治疗胃食管反流病

Laparoscopic Nissen fundoplication for treatment of gastroesophageal reflux disease

摘要:

目的：探讨腹腔镜Nissen胃底折叠术治疗胃食管反流病的效果。
方法：对近2年来收治的109例胃食管反流病实施腹腔镜Nissen胃底折叠术患者的临床资料进行回顾性分析。
结果：108例成功完成手术，1例因难以控制的脾上极胃短血管出血而中转开腹。手术用时30~245（平均68.1）min，术中出血5~450（平均30.0）mL；术后住院天数2~8（平均4.2）天。术后102例获3~27个月的随访，7例失访。随访患者中99例（97.1%）反酸、烧心等消化道症状基本消失，2例（2.0%）明显缓解，1例（0.9%）无效。术后2例出现较严重的吞咽困难，1例严重上腹胀气，2例腹泻，1例出现术后食管裂孔疝。
结论：腹腔镜Nissen胃底折叠术是治疗胃食管反流病的一种微创、安全、有效的治疗方法。

Abstract:

Objective: To observe the clinical effects and complications of laparoscopic Nissen fundoplication (LNF) in treatment of gastroesophageal reflux disease (GERD).
Methods:  From November 2006 to November 2008, 109 consecutive patients with GERD were treated by LNF. The clinical records of these patients were retrospectively analyzed.
Results: All patients, except one case converted to laparotomy because of bleeding from short gastric vessel.  The mean operation time was 〖JP2〗68.1 min (30-245 min); mean intraoperative blood loss was 30.0 mL (5-450 mL); and mean postoperative hospital stay was 4.2 d(2-8 d).Postoperatively, 102 patients were  followed-up for 3 to 27 months, and among them, 99 patients (97.1%) had complete resolution of their digestive symptoms such as regurgitation and heartburn, 2 patients (2.0%) had symptoms markedly relieved, and 1 patient (0.9%) had not improved. Postoperative complications included severe dysphagia in 2 cases, bloating in 1 case，diarrhea in 2 cases and postoperative hiatal hernia in 1 case.
Conclusions:  Laparoscopic Nissen fundoplication is a minimally-invasive, safe and effective procedure in the treatment of gastroesophageal reflux disease.