抗胃食管返流手术的探讨

胃食管返流病是上消化道最常见的疾患之一,发生并发症的部分病人需外科治疗。作者从1988年7月至1996年12月用各种抗返流手术方法治疗87例胃食管返流病人,其中包括77例滑动型食管裂孔疝,8例短食管,2例食管旁疝。48例用Nissen胃底折叠术,11例用Belsey 4号手术,3例用Collis-Nissen手术,1例用Thor手术,24例用作者自己设计的贲门斜行套叠术。3例Nissen手术术后复发,全组术后复发率和并发症发生率为6.9％(6/187)。从1993年开始施行贲门斜行套叠术,全部病人术后24h食管pH监测证明手术成功。结论:Nissen手术虽应用广泛,但难于操作和并发症多;相反,贲门斜行套叠术易于传授,疗效确实,有效地建立了抗返流屏障。

EXPLORATORY STUDY ON ANTIREFLUX PROCEDURES FOR GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal reflux disease (GERD) is one of the most common abnormalities of the upper gastrointestinal tract. Partial patients with complications of GERD call for surgical intervention. From July 1988 through December 1996, various antireflux operations were performed in 87 patients, including 77 cases of sliding hiatal hernia, 8 short esophagus and 2 paraesophageal hernia. Nissen's fundoplication was employed in 48 patients , Belsey Mark IV in 11, Collis - Nissen in 3, Thor repair in 1, and the cardiac oblique invagination (COI) designed by the authors in 24. Three cases of Nissen's fundoplication had postoperative recurrence. The recurrence rate and morbidity in this series were 6. 9 per cent (6/87). Since 1993, COI have been performed in 24 patients, which were proved to be successful by 24 - hour esophageal pH monitoring postoperatively. Conclusion: manipulation of Nissen's fundoplication is difficult and the morbidity is rather high even though it is the most commonly used in the field of surgical treatment for GERD. On the other hand, COI is a better operation which is easy to learn and will achieve durable relief from reflux because of the reconstruction of an effective antireflux barrior.