腹腔镜Nissen胃底折叠术治疗老年胃食管反流病

目的:对比腹腔镜Nissen 胃底折叠术在老年组和非老年组胃食管反流病(GERD)的疗效,评价其在老年人应用的可行性.方法:回顾分析因GERD行腹腔镜Nissen胃底折叠术治疗的老年病人28例,随机选取同时期非老年GERD病人40例作为对照组,分析不同年龄组患者的治疗效果.结果:术后两组症状完全消失.食管下段压力由(8.8±2.6)mmHg(1mmHg =0.133 kPa)提高到(18.23±3.6)mmHg(P＜ 0.01),24 h pH值检测评分由105.4±3.7降低到8.12±2.1(P＜ 0.01),较术前明显改善,并达到正常范围.平均随访4.5年,非老年组症状复发2例,老年组1例.远期吞咽困难老年组发生8例,非老年组为1例,差异有统计学意义(P＜ 0.05).结论:在老年GERD病人中实施腹腔镜Nissen 胃底折叠术与在非老年病人中实施一样安全、有效,但远期吞咽困难发生率较非老年人为高.

Laparoscopic Nissen Fundoplication in the Treatment of Elderly Patients with GERD

Objective To Compare the efficacy of laparoscopic Nissen fundopication for GERD in the elderly and non-elderly patients,and to evaluate the feasibility in the elderly patients.Methods Retrospective analyzed our database of 68 patients,who underwent laparoscopic Nissen fundopication for GERD.28 cases were elderly patients,and the other 60 were non-elderly patients.Result Symptoms disappeared completely in the two groups of patients.Esophageal pressure rose from (8.8±2.6)mmHg to (18.23±3.6)mmHg,and the 24 hours pH monitoring score decreased from 105.4±3.7 to 8.12±2.1.Both of them improved significantly compared with preoperative and reached the normal range.The average follow-up time was 4.5 years.The clinical symptoms recurred in 2 patients of non-elderly group and 1 patient of elderly group.Long-term dysphasia occurred in 8 patients of elderly group and 1 patient of non-elderly group.The difference was statistically significant P < 0.05.Conclusion Implementation of laparoscopic Nissen fundopication was safe and effective in elderly patients with GERD,which was the same in the non-elderly patients.But the incidence of long-term dysphasia was high in elderly patients.