共查询到20条相似文献,搜索用时 31 毫秒
1.
W. O. Richards R. H. Clements P. C. Wang C. D. Lind H. Mertz J. K. Ladipo M. D. Holzman K. W. Sharp 《Surgical endoscopy》1999,13(10):1010-1014
Background: There is still some controversy over the need for antireflux procedures with Heller myotomy in the treatment of achalasia.
This study was undertaken in an effort to clarify this question.
Methods: To determine whether Heller myotomy alone would cause significant gastroesophageal reflux (GER), we studied 16 patients who
had undergone laparoscopic Heller myotomy without concomitant antireflux procedures. Patients were asked to return for esophageal
manometry and 24-h pH studies after giving informed consent for the Institutional Review Board (IRB)-approved study at a median
follow-up time of 8.3 months (range, 3–51). Results are expressed as the mean ± SEM.
Results: Fourteen of the 16 patients reported good to excellent relief of dysphagia after myotomy. They were subsequently studied
with a 24-h pH probe and esophageal manometry. These 14 patients had a significant fall in lower esophageal sphincter (LES)
pressure from 41.4 ± 4.2 mmHg to 14.2 ± 1.3 mmHg, after the myotomy (p < 0.01, Student's t-test). The two patients who reported more dysphagia postoperatively had LES pressures of 20 and 25 mmHg, respectively. Two
of 14 patients had DeMeester scores of >22 (scores = 61.8, 29.4), while only one patient had a pathologic total time of reflux
(percent time of reflux, 8%). The mean percent time of reflux in the other 13 patients was 1.9 ± 0.6% (range, 0.1–4%), and
the mean DeMeester score was 11.7 ± 4.6 (range, 0.48–19.7).
Conclusions: Laparoscopic Heller myotomy is effective for the relief of dysphagia in achalasia if the myotomy lowers the LES pressure
to <17 mmHg. If performed without dissection of the entire esophagus, the laparoscopic Heller myotomy does not create significant
GER in the postoperative period. Clearance of acid refluxate from the aperistaltic esophagus is an important component of
the pathologic gastroesophageal reflux disease (GERD) seen after Heller myotomy for achalasia. Furthermore, GERD symptoms
do not correlate with objective measurement of GE reflux in patients with achalasia. Objective measurement of GERD with 24
h pH probes may be indicated to identify those patients with pathologic acid reflux who need additional medical treatment.
Received: 12 May 1998/Accepted: 15 December 1998 相似文献
2.
G J Maddern J C Myers N McIntosh F H Bridgewater G G Jamieson 《Archives of surgery (Chicago, Ill. : 1960)》1991,126(11):1418-1422
The effects of the Angelchik prosthesis on esophageal and gastric function were investigated in 17 patients (11 men and six women; median age, 57 years; age range, 36 to 88 years) who underwent surgery for treatment of gastroesophageal reflux disease. All patients demonstrated unequivocal reflux, either at endoscopy or 24-hour pH testing. There was a significant increase in lower esophageal sphincter pressure after surgery, and no patient demonstrated abnormal reflux on pH testing. Gastric emptying of liquids and solids was not altered by surgery. Six months after surgery, all symptoms except dysphagia had significantly improved. Thirty-three months after surgery, six patients described symptoms as severe as or worse than those before surgery. Four patients had the prosthesis removed, two because of dysphagia alone, one because of reflux and dysphagia, and one because of flatulence and bloating. The patients who required removal of the prosthesis because of dysphagia had gross delay of esophageal emptying. We conclude that the Angelchik prosthesis is an effective antireflux device, but it interferes with esophageal function in some patients, requiring removal of the prosthesis. We think the rate of removal of the prosthesis is too high for its routine use in the treatment of gastroesophageal reflux disease. 相似文献
3.
Gruebel C Linke G Tutuian R Hebbard G Zerz A Meyenberger C Borovicka J 《Surgical endoscopy》2008,22(5):1241-1247
Background Reflux monitoring using combined multichannel intraluminal impedance (MII) and pH-metry increases the sensitivity for identifying
gastroesophageal reflux episodes. The likelihood of a positive symptom index (SI) for patients with reflux disease (gastroesophageal
reflux disease [GERD] or nonerosive reflux disease [NERD]) receiving proton pump inhibitor (PPI) treatment has been used to
select candidates for antireflux surgery. Little is known about the advantages of MII-pH monitoring compared with pH monitoring
alone for evaluating GERD/NERD patients off PPI treatment considered as candidates for antireflux surgery or for assessing
changes in MII-pH-detected reflux episodes after antireflux surgery. This study aimed to determine the additional value of
MII over pH-metry alone for patients off PPI treatment before and after antireflux surgery.
Methods For this study 12 patients (4 women and 8 men; mean age, 45 years; range, 27–74 years) were evaluated using ambulatory MII-pH
monitoring before and 3 months after mesh-augmented hiatoplasty. Reflux events were identified by MII-pH (A) and pH-metry
(B) as patients recorded symptoms on a data logger. For each symptom, a symptom index was calculated for reflux events identified
by MII-pH and by pH-monitoring alone.
Results Preoperatively, MII-pH monitoring identified 71.9 ± 8.4 reflux episodes, whereas pH monitoring identified only 51.0 ± 7.8
(p < 0.05). Postoperatively, MII-pH monitoring identified 35.5 ± 6.6 reflux episodes, whereas pH monitoring identified only
19.6 ± 4.7 (p < 0.05). The pre- and postoperative symptom index for MII-pH monitoring was higher than pH monitoring (preoperative 91.7%
vs 25%, p = 0.006; postoperative 50% vs 16.7%, p = 0.012).
Conclusion Combined MII-pH-metry improves the pre- and postoperative assessment of GERD patients off PPI and results in a higher symptom-reflux
association. 相似文献
4.
Laparoscopic antireflux surgery has become the standard operation for gastroesophageal reflux disease (GERD). This study examined
the outcomes of laparoscopic antireflux surgery, hypothesizing that both subjective symptoms and objective pH would correlate
with manometric parameters to reflect the absence of reflux after fundoplication. We evaluated 56 patients who underwent laparoscopic
antireflux surgery. Preoperative and postoperative symptoms were documented by chart reviews and confirmed by telephone interviews
with the patient. Preoperative pH probe and esophageal manometry studies were compared with postoperative studies performed
3 to 6 months after fundoplication. Subjective symptoms were correlated with objective measurements of acid reflux and lower
esophageal sphincter pressure (LESP). The follow-up period was 3 to 29 months. Symptomatic improvement was seen in 91% of
patients, and good to excellent improvement in preoperative symptoms was cited. Postoperatively, there was significant improvement
in percentages of upright supine times when esophageal pH was less than 4 (p <0.001). There was an increase in LESP from an
average of 16.9 mmHg preoperatively to 22.7 mmHg postoperatively (p <0.001). There was no correlation between postoperative
LESP and symptoms or LESP and 24-h pH results. However, there was a predictive correlation between LESP and postoperative
heartburn symptoms (p <0.001). These findings imply that symptom follow-up evaluation is adequate in the asymptomatic patient
after laparoscopic fundoplication, and that routine physiologic testing is not necessary. 相似文献
5.
Purpose: Both surgical and conservative treatments for gastroesophageal reflux disorder (GERD) are controversial. The aim of this
prosepective study was to examine outcomes after laparoscopic antireflux surgery.
Methods: The subjects were 143 patients who underwent laparoscopic antireflux surgery. Following diagnostic procedures 126 patients
were allocated to a total fundoplication group (360°C, Nissen-DeMeester) and 17, to a posterior semifundoplication group (250–270°,
Toupet). All complications were registered, and pathophysiological and outcome data were examined 3, 6, and 9 months after
surgery.
Results: By 6 months after surgery the mean lower esophageal sphincter (LES) pressure had improved significantly, to 14.8 mmHg in
the Nissen-DeMeester group, and to 12.1 mmHg in the Toupet group, corresponding to successful prevention of esophageal reflux
in both groups. Dysphagia was more common in the early postoperative period after total fundic wrap (17% vs 12%), but this difference disappeared in time. All patients reported complete relief of reflux symptoms, although two of those
who underwent the Nissen-DeMeester fundoplication experienced relapse of GERD and required open reconstruction (1.4%). The
laparoscopic procedure was converted to open surgery in three patients (2%). There were no associated deaths and the perioperative
complication rate was 4.2%.
Conclusion: Laparoscopic antireflux surgery is an effective treatment for GERD. More than 93% of the patients in this series rated their
outcome as good to excellent following the operation.
Received: December 10, 2001 / Accepted: May 7, 2002
Reprint requests to: K. Ludwig 相似文献
6.
7.
H.B. Zhou H. Yan S.L. Zou L.Q. Wang Y.Z. Qiao L.X. Wang 《Acta chirurgica Belgica》2013,113(4):287-291
Background : This study was designed to investigate the effect of a novel surgical method on cardia sphincter function and complication rates after Heller’s cardiomyotomy for patients with achalasia.Methods : Forty-eight patients (19 males, mean age 34.0 ± 10.5 years, range, 12–58) were included in this study. A spindle diaphragm valve was used in the surgery to rebuild the cardiac sphincter function. The efficacy of the surgery was determined by clinical assessment of symptoms and lower esophageal sphincter pressure (LESP) measurements. Barium meal examination was also used to evaluate the efficacy.Results : The mean LESP before surgery was 41.3 ± 11.6 mmHg. It was reduced to 16.8 ± 3.7 mmHg and 17.5 ± 2.5 mmHg 3 and 12 months after surgery (P < 0.01). All patients were free of symptoms such as swallow difficulties or acid reflux during the follow up. However, barium swallow examination showed that 1 patient had mild reflux after the surgery. Clinical symptom scores on swallow difficulties/obstruction was reduced from 2.5 ± 0.65 before surgery to 0.06 ± 0.24 12 months after the surgery (P < 0.01).Conclusion : A spindle diaphragm valve used with Heller’s cardiomyotomy was associated with a very low incidence of post-surgical complications, such as gastroesophageal reflux. This technique may be used in treating all patients with achalasia. 相似文献
8.
《The Annals of thoracic surgery》1986,41(2):135-142
Minimal data are available about the Angelchik antireflux prosthesis although it has been inserted in more than 14,000 patients. The present animal study was designed to evaluate the effectiveness and mechanism of action of this prosthesis. A reproducible model of esophageal reflux in primates was created using a double myotomy. Lower esophageal sphincter (LES) pressure and reflux score were improved significantly in animals by insertion of an Angelchik antireflux prosthesis, a modified antireflux prosthesis, or a Nissen fundoplication. Manometrically determined LES length was increased after insertion of an Angelchik antireflux prosthesis but not by a Nissen fundoplication or sham operation. Complications after insertion of the modified prosthesis included intraluminal erosion, fibrous stricture, and slippage of the device over the stomach. 相似文献
9.
Laparoscopic toupet fundoplication for gastroesophageal reflux disease with poor esophageal body motility 总被引:5,自引:2,他引:5
Richard J. Lund M.D. Gerold J. Wetcher M.D. Frank Raiser M.D. Karl Glaser M.D. Galen Perdikis M.D. Michael Gadenstätter M.D. Natsuya Katada M.D. Charles J. Filipi M.D. Ronald A. Hinder M.D. Ph.D. 《Journal of gastrointestinal surgery》1997,1(4):301-308
Impaired esophageal body motility is a complication of chronic gastroesophageal reflux disease (GERD). In patients with this
disease, a 360-degree fundoplication may result in severe postoperative dysphagia. Forty-six patients with GERD who had a
weak lower esophageal sphincter pressure and a positive acid reflux score associated with impaired esophageal body peristalsis
in the distal esophagus (amplitude <30 mm Hg and >10% simultaneous or interrupted waves) were selected to undergo laparoscopic
Toupet fundoplication. They were compared with 16 similar patients with poor esophageal body function who underwent Nissen
fundoplication. The patients who underwent Toupet fundoplication had less dysphagia than those who had the Nissen procedure
(9% vs. 44%;P=0.0041). Twenty-four-hour ambulatory pH monitoring and esophageal manometry were repeated in 31 Toupet patients 6 months
after surgery. Percentage of time of esophageal exposure to pH <4.0, DeMeester reflux score, lower esophageal pressure, intra-abdominal
length, vector volume, and distal esophageal amplitude all improved significantly after surgery. Ninety-one percent of patients
were free of reflux symptoms. The laparoscopic Toupet fundoplication provides an effective antireflux barrier according to
manometric, pH, and symptom criteria. It avoids potential postoperative dysphagia in patients with weak esophageal peristalsis
and results teria. It avoids potential postoperative dysphagia in patients with weak esophageal peristalsis and results in
improved esophageal body function 6 months after, surgery.
Presented at the Thirty-Seventh Annual Meeting of The Society for Surgery of the Alimentary Tract, San Francisco, Calif.,
May 19–22, 1996. 相似文献
10.
11.
Background: Transient lower esophageal sphincter relaxation (TLESR) is the most common mechanism underlying gastroesophageal reflux disease (GERD), causing 70% to 100% of the reflux episodes in normal subjects and 63% to 74% of the reflux episodes in patients with reflux disease. This study aimed to evaluate the effect of laparoscopic Nissen fundoplication on TLESR in patients with proven GERD. Methods: We prospectively followed 73 consecutive patients (13 men and 60 women; mean age, 43.7 ± 1.72 years) with proven diagnosis of GERD and reported TLESRs found during a 40-min esophageal manometric study. These patients had repeat testing 6 months after undergoing laparoscopic Nissen fundoplication. Results: Laparoscopic Nissen fundoplication increased the basal and nadir lower esophageal sphincter (LES) pressure and significantly reduced the number of TLESRs during the manometric study. No patients after surgery exhibited TLESR with nadir less than 2 mmHg. However, 8 of the 73 patients (11%) exhibited TLESR to a nadir exceeding 50% of basal pressure (mean nadir, 5.0 ± 1.07 mmHg). Conclusions: The number of TLESRs is reduced significantly by antireflux surgery. Even accounting for increased basal and nadir pressures, the incidence of TLESR is reduced, suggesting that there may be additional mechanisms involved in this process. 相似文献
12.
Purpose Laparoscopic antireflux surgery (LARS) has long been introduced as an alternative method for the treatment of gastroesophageal
reflux disease (GERD) in young adults. However, the safety of this procedure and the associated improvement in the quality
of life for the elderly are rarely discussed. This study compared the results between young and elderly patients who underwent
laparoscopic fundoplication for the treatment of GERD.
Methods From January 1999 to January 2006, there were 231 adult patients who underwent LARS for GERD at a single institute. Among
all patients, 33 patients were older than 70 years old (14.3%, 73.0 ± 1.9, range 70–76), 198 patients were younger than 70
years old (85.7%, 46.6 ± 11.5, range 20–69). The clinical characteristics, operation time, postoperative hospital stay, surgical
complications, and quality of life were retrospectively analyzed.
Results The mean operation time had no significant difference between the younger group and the elderly group. The mean postoperative
hospital stay in the elderly group was slightly longer than the younger group (4.1 ± 2.5 days vs 3.4 ± 1.3 days, P = 0.19). There were no mortalities and no major complications found in each group. No patients required conversion to an
open procedure. Four patients had minor complications (three in the elderly group, rate: 9.0%; one in the younger group, rate:
0.5%, P < 0.05). There were two patients in the nonelderly group who had recurrence. A comparison of the preoperative and postoperative
Gastro-Intestinal Quality of Life Index (GIQLI) scores showed significant improvements (99.3 ± 19.2 points, and 110.2 ± 20.6
points, respectively, P < 0.05) with no significant difference between the two groups.
Conclusion Laparoscopic antireflux surgery thus appears to provide an equivalent degree of safety and symptomatic relief for elderly
patients with GERD as that observed in young patients. 相似文献
13.
Matthew J. D’Alessio Dean Arnaoutakis Natalie Giarelli Desiree V. Villadolid Alexander S. Rosemurgy 《Journal of gastrointestinal surgery》2005,9(7):949-954
Obesity has been shown to be a significant predisposing factor for gastroesophageal reflux disease (GERD). However, obesity
is also thought to be a contraindication to antireflux surgery. This study was undertaken to determine if clinical outcomes
after laparoscopic Nissen fundoplications are influenced by preoperative body mass index (BMI). From a prospective database
of patients undergoing treatment for GERD, 257 consecutive patients undergoing laparoscopic Nissen fundoplication were studied.
Patients were stratified by preoperative BMI: normal (<25), overweight (25-30), and obese (>30). Clinical outcomes were scored
by patients with a Likert scale. Overweight and obese patients had more severe preoperative reflux, although symptom scores
for reflux and dysphagia were similar among all weight categories. There was a trend toward longer operative times for obese
patients. Mean follow-up was 26 ± 23.9 months. Mean heartburn and dysphagia symptom scores improved for patients of all BMI
categories (P < 0.001). Postoperative symptom scores and clinical success rates did not differ among BMI categories. Most patients undergoing
laparoscopic Nissen fundoplication are overweight or obese with moderate dysphagia and severe acid reflux. Clinical outcomes
after laparoscopic Nissen fundoplication did not differ among patients stratified by preoperative BMI. Obesity is not a contraindication
to laparoscopic Nissen fundoplication.
Presented at the Forty-Fifth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May
15–19, 2004 相似文献
14.
Anne Blomqvist R.N. Jan Daknbäck M.D. Ph.D. Cecilia Hagedorn M.D. Hans Lönroth M.D. Ph.D. Anders Hyltander M.D. Ph.D. Lars Lundell M.D. Ph.D. 《Journal of gastrointestinal surgery》2000,4(5):493-500
With the objective of further optimizing the outcome of antireflux surgery, we have studied the importance of dividing the
short gastric vessels when performing a laparoscopic total fundoplication. Ninetynine consecutive patients with chronic gastroesophageal
reflux disease (GERD) were enrolled in the trial. Forty-seven patients (25 men, age 52 ±1.6 years [mean ± standard error])
were randomized to undergo a laparoscopic Nissen-Rossetti total fundic wrap with intact short gastric vessels, whereas 52
patients (29 men, 48 ±1.4 years) had complete division of these vessels. Quality of life was assessed by means of the psychological
general well-being and gastrointestinal symptom rating scale indices. The 6- and 12-month follow-up data are reported. Two
patients were converted to open surgery. Mobilization of the fundus significantly prolonged the operative time (120 vs. 104
minutes, P = 0.05); otherwise the complication rates were similar in the two groups. Both procedures were equally effective in controlling
gastroesophageal reflux at 6 and 12 months’ postoperatively. Division of the short gastric vessels had no significant impact
on the point prevalence of postfundoplication complaints at the given follow-up time points. Quality of life was significantly
improved by both operative procedures and remained “normal” throughout the followup period. Dividing all short gastric vessels
had no impact on the functional outcome during the first year of recovery after a total laparoscopic fundoplication.
Supported by grants from the Swedish Medical Research Council. 相似文献
15.
Immediate and delayed effects of laparoscopic Nissen fundoplication on pulmonary function 总被引:1,自引:1,他引:0
Background: An effort was made to assess the respiratory outcomes of laparoscopic Nissen fundoplication (LNF).
Methods: Prospective follow-up of 69 patients undergoing LNF for gastroesophageal reflux disease. Outcomes included pulmonary function
testing, 24-h pH recording, esophageal manometry, and symptom assessment.
Results: There was an improvement (p < 0.0001) in heartburn and cough scores. There was a significant fall in spirometry (p < 0001), diffusing capacity (p < 0.0001), and respiratory muscle strength (p < 0.0001) 36 h after surgery, which had returned to baseline by 1 month. At 6 months, the patients (n= 16) with impaired preoperative diffusing capacity showed improvement (17.8 ± 3.7 to 19.8 ± 4.6 ml/min/mmHg, p= 0.0245).
Conclusion: Patients undergoing LNF have impaired gas exchange before surgery which tends to improve 6 months after surgery. There is
an early reversible impairment in respiratory function due to diaphragm dysfunction. Patients with a preoperative 1-s forced
expired volume > 1.5, or 50% predicted, are unlikely to develop signficant early respiratory complication.
Received: 22 April 1996/Accepted: 9 July 1996 相似文献
16.
Freitag CP Kruel CR Duarte ME Sanches PR Thomé PR Fornari F Driemeier D Teixeira F Mollerke RO Callegari-Jacques SM Barros SG 《Surgical endoscopy》2009,23(6):1272-1278
Background and aims Endoscopic injection of filler agents into the esophagogastric junction has been developed to augment the antireflux barrier
and decrease gastroesophageal reflux (GER). However, evidence of efficacy is lacking and serious complications have been reported
in humans. The aim of this study was to assess whether endoscopic implantation of polymethylmethacrylate augments the antireflux
barrier in a porcine model for GER.
Methods Large White pigs underwent esophageal manometry, gastric yield pressure (GYP), and gastric yield volume (GYV) measurements
and implantation of PMMA in the distal esophagus under general anesthesia. After follow-up of 28 days, esophageal manometry
and gastric yield measurements were repeated and animals sacrificed.
Results Implantation of PMMA was performed in 18 animals, and 14 animals survived 28 days. There was a significant increase in GYP
(10.7 mmHg versus 8.1 mmHg; p = 0.017) and GYV (997 ml versus 393 ml; p < 0.001) after PMMA implantation, whereas resting LES pressure did not change significantly. Acute inflammatory changes and
fibrous tissue deposits were found surrounding the PMMA implants during histology. One animal died after esophageal perforation
and three others due to pneumonia (two) and colon perforation (one) in the postoperative period.
Conclusions Endoscopic implantation of PMMA in the distal esophagus augments the antireflux barrier 28 days after the procedure. However,
esophageal perforation points to the need for technical refinements to make the procedure safer. 相似文献
17.
Background: Conflicting results regarding the influence of laparoscopic adjustable gastric banding (LAGB) on gastroesophageal
reflux disease (GERD) have been published. Methods: A prospective follow-up study was conducted in 31 patients (male/female
5/26, mean age 44 ± 11 SD years) with 24-hour pH and manometry recordings, symptom assessment, and upper GI endoscopy. Results:
Total number of reflux episodes decreased from a mean value of 44.6 ± 23.7 SD preoperatively to 22.9 ± 17.1 postoperatively
(P=0.0006), after a median follow-up time of 19 months (range 7-32 months). Total reflux time decreased from 9.5% ± 6.2% to
3.5% ± 3.7%, P=0.0009, and DeMeester score decreased from 38.5 ± 24.9 to 18.6 ± 20.4, P=0.03. Symptomatic patients decreased from 48.4% preoperatively to 16.1% postoperatively (P=0.01), medication for GERD decreased from 35.5% to 12.9% (P=0.05), and the diagnosis of GERD on 24-hour pH recordings decreased from 77.4% to 37.5% (P=0.01). There were no pouch enlargements seen on upper GI endoscopy. Esophageal motility was unchanged, but 36% of the patients
had incomplete relaxation of the lower esophageal sphincter following the operation (P<0.0001). Mean BMI decreased from 46.0 ± 5.46 to 38.4 ± 6.45 (P<0.0001), excess weight from 60.0 kg ± 18.58 kg, 44.9% ± 6.56% to 38.4 kg ± 20.27 kg, 28.4% ± 10.97% (P<0.0001). No association between the postoperative diagnosis of GERD and the amount of weight loss could be found. Conclusions:
The correctly placed gastric band is an effective anti-reflux barrier in the short term. Long-term results have to be awaited. 相似文献
18.
Objective To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication
and to evaluate the success rate of these procedures.
Summary background data Nissen fundoplication (360°) is the standard operation in the surgical management of gastroesophageal reflux disease (GERD).
In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal
motility. Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been
recommended to use the Toupet procedure (270°) in these patients. We performed a randomized trial to evaluate this tailored
concept and to compare the two operative techniques concerning reflux control and complication rate (dysphagia).
Methods 200 patients with GERD were included in a prospective, randomized study. After preoperative examinations (clinical interview,
endoscopy, 24-hour pH-metry and esophageal manometry) 100 patients underwent either a laparoscopic Nissen procedure (50 with
and 50 without motility disorders), or Toupet (50 with and 50 without motility disorders). Postoperative follow-up after two
years included clinical interview, endoscopy, 24-hour pH-metry, and esophageal manometry.
Results After two years 85% (Nissen) and 85% (Toupet) of patients were satisfied with the operative result. Dysphagia was more frequent
following a Nissen fundoplication compared to Toupet (19 vs. 8, p < 0.05) and did not correlate with preoperative motility. Concerning reflux control the Toupet proved to be as good as the
Nissen procedure.
Conclusion Tailoring antireflux surgery according to the esophageal motility is not indicated, as motility disorders are not correlated
with postoperative dysphagia. The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good
as the Nissen fundoplication in controlling reflux. 相似文献
19.
Manfred P. Ritter M.D. Jeffrey H. Peters M.D. Tom R. DeMeester M.D. Peter F. Crookes M.D. Rodney J. Mason M.D. Lydia Green Lemeneh Tefera Cedric G. Bremner M.D. 《Journal of gastrointestinal surgery》1998,2(6):567-572
With the advent of laparoscopic surgery and the recognition that gastroesophageal reflux disease often requires lifelong medication,
patients with normal resting sphincter characteristics are now being considered for surgery. The outcome of these patients
after fundoplication is unknown and formed the basis of this study. The study population consisted of 123 patients undergoing
laparoscopic Nissen fundoplication between 1992 and 1996. All patients had increased esophageal acid exposure on 24-hour esophageal
pH monitoring. Patients were divided into those with a normal (n = 36) and those with a structurally defective (n = 87) lower
esophageal sphincter (LES), based on LES resting pressure (normal >6 mm Hg), overall length (normal >2 cm), and abdominal
length (normal > 1 cm), and their outcomes were assessed. Each group was subsequently divided into patients presenting with
a primary symptom that was "typical" (heartburn, regurgitation, or dysphagia) or "atypical" (gastric, respiratory, or chest
pain) of gastroesophageal reflux, and outcome was assessed. Median duration of follow-up was 18 months after surgery. Overall,
laparoscopic fundoplication was successful in relieving symptoms of gastroesophageal reflux in 90% of patients. Patients with
a typical primary symptom had an excellent outcome irrespective of the resting status of the LES (95% and 97%, respectively).
Atypical primary symptoms were significantly more common in patients with a normal LES (29%) than in those with a structurally
defective LES (10%; P <0.05), and these symptoms were less likely (50%) to be relieved by antireflux surgery. Laparoscopic
antireflux surgery is highly successful and not dependent on the status of the resting LES in patients with increased esophageal
acid exposure and primary symptoms "typical" of gastroesophageal reflux. Antireflux surgery should be applied cautiously in
patients with atypical primary symptoms.
Presented in part at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C.,
May 11–14,1997. 相似文献
20.
Katarzyna Blazejczyk Andreas Hoene Anne Glitsch Alexandra Busemann Claus Dieter Heidecke Maciej Patrzyk 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2013,398(8):1107-1114