Evaluation of Current Operations for the Prevention of Gastroesophageal Reflux
Evaluation of Current Operations for the Prevention of Gastroesophageal Reflux
复制标题
当前预防胃食管反流手术的评估
作者：
L. T. R. DEMEESTER;L. L. F. JOHNSON;Alfred H. Kent
对45例患者进行了前瞻性随机研究，以评价Hill、Nissen或Belsey抗反流手术的有效性。所有患者均有GE反流症状，对药物治疗无反应，+标准酸反流试验（SART）和食管炎（38/45）或+ Burnstein试验（7/45）。术前和154天（平均）进行食管症状、放射学、测压和pH（SART和24小时监测）评价。手术后所有手术均改善了灼伤症状。最好的改善是在Nissen修复后。所有手术均使远端食管括约肌（DES）压力增加至术前水平。尼森河和贝尔西河比希尔河增加了更多。括约肌长度和动力学保持不变。Nissen手术将更多的测压括约肌置于腹部正压环境中的呼吸倒置点以下。Nissen和Hill修复术增加了食管长度。这被认为是Nissen和Hill修复术后暂时性吞咽困难发生率较高以及Belsey修复术后发生率较低的原因。如SART和24小时食管pH监测所示，Nissen修复术最有效地防止了反流，这是一种敏感的反流频率和持续时间测量方法。平均住院时间Belsey为20天，Nissen和Hill手术均为12天。术后并发症在胸部手术中比腹部手术更常见。Hill修复术后呕吐能力最强，Belsey和Nissen修复术后呕吐能力最弱。所有手术都暂时增加了排气量。可以得出结论，Nissen修复术通过提供DES压力的最大增加和将更多的括约肌置于积极的腹部环境中来最好地控制反流及其症状。这是以最低的发病率完成的，但代价是术后暂时性吞咽困难和50%的机会在修复后无法呕吐。
A prospective randomized study was done on 45 patients to evaluate the effectiveness of the Hill, Nissen or Belsey anti-reflux procedure. All patients had symptoms of GE reflux unresponsive to medical therapy, a + standard acid reflux test (SART), and esophagitis (38/45) or + Burnstein test (7/45). Esophageal symptomatic, radiographic, manometric and pH (SART and 24-hr monitoring) evaluation was done pre- and 154 days (ave.) postsurgery. All procedures improved the symptoms of pyrosis. The best improvement was seen after the Nissen repair. All procedures increased the distal esophageal sphincter (DES) pressures over preoperative levels. The Nissen and Belsey increased it more than the Hill. Sphincter length and dynamics remained unchanged. The Nissen procedure placed more of the manometric sphincter below the respiratory inversion point in the positive pressure environment of the abdomen. The esophageal length was increased by the Nissen and Hill repairs. This was thought to account for the high incidence of temporary postsurgery dysphagia following the Nissen and Hill repairs and the lower incidence following the Belsey repair. Reflux was most effectively prevented by the Nissen repair, as shown by the SART and the 24-hr esophageal pH monitoring, a sensitive measurement of frequency and duration of reflux. The average length of hospital stay was 20 days for Belsey and 12 days for both Nissen and Hill procedure. Postsurgery complications were more common following the thoracic than the abdominal approach. Ability to vomit postrepair was greatest with the Hill and least with the Belsey and Nissen repair. All procedures temporarily increased amount of flatus. It is concluded that the Nissen repair best controls reflux and its symptoms by providing the greatest increase in DES pressure and placing more of the sphincter in the positive abdominal environment. This is accomplished with the lowest morbidity but at the expense of temporary postoperative dysphagia and a 50% chance of being unable to vomit after the repair.