Laparoscopic antireflux surgery: comparative study of Nissen, Nissen-Rossetti, and Toupet fundoplication
Laparoscopic antireflux surgery: comparative study of Nissen, Nissen-Rossetti, and Toupet fundoplication
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腹腔镜抗反流手术：Nissen、Nissen-Rossetti 和 Toupet 胃底折叠术的比较研究
DOI：
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发表时间：
2000
期刊：
影响因子：
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通讯作者：
Société Française de Chirurgie Laparoscopique
中科院分区：
文献类型：
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作者：
P. Pessaux;J. Arnaud;B. Ghavami;J. Flament;G. Trebuchet;C. Meyer;N. Huten;G. Champault;Société Française de Chirurgie Laparoscopique
摘要背景：本回顾性研究的目的是比较Nissen、Nissen-Rossetti和Toupet腹腔镜胃底折叠术治疗胃食管反流病（GERD）的结果。
研究方法：从1992年到1996年，1,470例腹腔镜胃底折叠术使用三种手术之一：Nissen（n = 655），Nissen-Rossetti（n = 423）和Toupet（n = 392）。术前检查包括1，437例患者（97.7%）的食管胃镜检查，934例患者（63.5%）的食管测压，799例患者（54.3%）的24小时pH值测定。结果估计为1个月、3个月和2年。通过电话联系无法访问医院中心的患者。
结果：三组在人口统计学数据（如年龄、性别、术前临床症状和GERD持续时间）方面非常相似。发生1例死亡（0.07%）。在3个月时，三组之间在转换、发病率、吞咽困难、早期再干预或术后住院时间方面没有差异。在Toupet手术中，手术时间更重要。在尼森组中，Visick I级患者较少，但Visick III级患者较多。2年时，复发率和再干预率相似。总体残留重度吞咽困难发生率为0.35%（n = 5）。在尼森组中，Visick I级患者较少，但Visick II级患者较多。组间Visick III级和IV级无差异。90%以上的患者满意（Visick I + Visick II），三组之间无显著差异。
结论：本研究的结果与文献中报告的数据无显著差异，表明此类手术技术有效且耐受性良好，两者均可适当用于治疗GERD。
AbstractBackground: The aim of this retrospective study was to compare the results of Nissen, Nissen-Rossetti, and Toupet laparoscopic fundoplication in terms of gastroesophageal reflux disease (GERD).
Methods: From 1992 to 1996, 1,470 laparoscopic fundoplications were performed using one of three procedures: Nissen (n= 655), Nissen-Rossetti (n= 423), and Toupet (n= 392). Preoperative checkup included esophagogastroduodenoscopy in 1,437 patients (97.7%), esophageal manometry in 934 patients (63.5%), and 24-h pH-metry in 799 patients (54.3%). The results were estimated at 1 month, 3 months, and 2 years. Patients unable to visit the hospital center were contacted by telephone.
Results: The three groups were quite similar regarding demographic data such as age, gender, preoperative clinical symptoms, and duration of GERD. One death (0.07%) occurred. At 3 months, there were no differences among the three groups concerning conversion, morbidity, dysphagia, early reintervention, or postoperative length of stay. The length of surgery was more important in the Toupet procedure. In the Nissen group, there were fewer Visick grade I patients but more Visick grade III patients. At 2 years, the recurrence and reintervention rates were similar. The overall residual severe dysphagia rate was 0.35% (n= 5). In the Nissen group, there were fewer Visick grade I patients but more in Visick grade II patients. There was no difference in Visick grade III and IV among the groups. More than 90% of the patients were satisfied (Visick I + Visick II), with no significant difference among the three groups.
Conclusions: The results of this study do not differ significantly from the data reported in the literature, suggesting such surgical techniques are effective and well tolerated, and that both can be properly used in the treatment of GERD.