摘要
目的：比较腹腔镜下Nissen、Toupet和Dor胃底折叠术治疗食管裂孔疝（HH）合并胃食管反流病（GERD）的临床疗效和安全性。方法回顾性分析2012年12月至2015年1月间新疆维吾尔自治区人民医院收治的276例HH合并GERD患者的病例资料，其中149例患者行腹腔镜Nissen胃底折叠术（Nissen组），41例患者行腹腔镜Toupet胃底折叠术（Toupet组），86例患者行Dor胃底折叠术（Dor组），分别比较3组患者的食管反流情况、食管压力、GERD Q量表评分数据及术中术后恢复情况等。结果除Toupet组在减少长反流次数和最长反流时间方面疗效并不明显外（均P＞0．05），3组患者术后反流情况较术前均得到明显改善（均P＜0．05）。对术后反流情况进行组间比较发现，3种术式术后反流时间、酸反流时间比例、最长反流时间比例和DeMeester评分差异均无统计学意义（均P ＞0．05）。但Dor组在减少反流次数及抑制长反流上优于Toupet组，差异有统计学意义[反流次数：（14．36±10．58）次比（29．83±19．71）次，长反流次数：（0．64±0．21）次比（6．20±3．48）次；均P＜0．05]，但两组在抑制长反流方面均逊于Nissen组[（0．38±0．16）次，均P ＜0．05]。和术前比较，三组术后食管下括约肌压力和残余压均明显升高，松弛率明显减少，差异均有统计学意义（均P ＜0．05）；但Toupet组术后无效吞咽次数较术前有所增加，差异有统计学意义[（11．25±2．04）次比（6．36±3．26）次，P ＜0．05]。Toupet组与Dor组的食管压力比较示，Dor组在食管下括约肌压力（静息呼吸平均值）的恢复[（20．69±13．95） mmHg比（12．91±6．89） mmHg]和无效吞咽的减少[（9．15±6．44）次比（11．25±2．04）次]方面均优于Toupet组（均P ＜0．05），但与Nissen组相当[食管下括约肌压力（静息呼吸平均值）：（19．87±10．40） mmHg，无效吞咽
Objective To compare the efficacy and safety among laparoscopic Nissen , Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease （GERD）. Methods Clinical data of 276 patients of hiatal hernia complicated with GERD undergoing operation in our hospital from December 2012 to January 2015 were retrospectively analyzed , including 149 patients of laparoscopic Nissen fundoplication （Nissen group）, 41 of laparoscopic Toupet fundoplication （Toupet group）, and 86 patients of laparoscopic Dor fundoplication （Dor group）. Esophageal reflux status, esophageal manometry, GERD Q rating scale, and postoperative recovery were compare among the three groups. Results Reflux status was improved significantly in the three groups after operation （all P 0.05）. There were no significant differences in postoperative reflux time, acid reflux time ratio, reflux longest time ratio, DeMeester score among the three groups （all P 〉 0.05）. Pairwise comparison showed that Dor group was significantly better than Toupet group in reducing the number of reflux episode （14.36 ± 10.58 vs. 29.83 ± 19.71） and long-reflux （0.64±0.21 vs. 6.20 ± 3.48）（both P 0.05]. The GERD Q scores were significantly decreased after operation in 3 groups （Nissen group：10.94 ± 2.20 vs.7.41 ± 1.43, t=11.667, P=0.001;Toupet group：10.91 ± 2.02 vs.7.18 ± 1.33, t=5.109, P=0.005; Dor group： 10.69±1.69 vs. 7.10±1.30, t = 7.610, P=0.002）. There was no significant difference in GERD Q scores among three groups （F = 1.465, P = 0.207）. The operative time, blood loss, hospital stay and complications were not significantly different among 3 groups （all P 〉 0.05）. Follow-up period was 12-51 months （median 19 months）, and no significant difference in recurrence was found [Nissen group： 2 cases （1.3%）, Toupet group：1 case （2.4%）, Dor group：1 case （1.2%）,χ2=0.363, P=0.834]. Conclusions It is safe and feasible for these three laparoscopic fundop
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第9期1014-1020,共7页
Chinese Journal of Gastrointestinal Surgery
关键词
食管裂孔疝
胃食管反流病
胃底折叠术
临床对比分析
Hiatal hernia
Gastroesophageal reflux disease
Fundoplication
Clinical comparison
