中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
8期
814-818
,共5页
杜航向%谭戈文%杨治力%王志刚
杜航嚮%譚戈文%楊治力%王誌剛
두항향%담과문%양치력%왕지강
胃食管反流病%腹腔镜Nissen术式%腹腔镜Toupet术式%Meta分析
胃食管反流病%腹腔鏡Nissen術式%腹腔鏡Toupet術式%Meta分析
위식관반류병%복강경Nissen술식%복강경Toupet술식%Meta분석
Gastro-oesophageal reflux disease%Laparoscopic,Nissen surgery%Laparoscopic,Toupet surgery%Meta analysis
目的 比较腹腔镜Nissen手术与Toupet手术在治疗胃食管反流病的疗效以及术后并发症的发生率.方法 通过Pubmed,Medline,Embase以及Cochrane图书馆数据库进行文献检索,用Nissen,Toupet,fundoplication[ Mesh]为关键词,仅将比较腹腔镜Nissen以及Toupet两种手术方式的随机对照研究纳入本研究,分别统计两组患者在术后早期(3～6个月)以及术后晚期(1～3年)的烧心、反酸、吞咽困难、胸痛、腹胀、不能打嗝、腹泻、术后早期并发症的发生率及满意度等.结果 在纳入本研究的7个随机对照研究总计939例患者中,腹腔镜Nissen手术478例,腹腔镜Toupet手术461例.两组患者的反流症状均得到了良好的控制,术后烧心的发生率差异无统计学意义(OR=1.01,95％CI:0.48～2.13,P=0.97).尽管Toupet组在术后早期及晚期吞咽困难的发生率显著低于Nissen组(OR=3.34,95％CI:2.22～5.02,P＜0.01),但前者术后早期并发症的发生率显著高于后者(OR=0.31,95％CI:0.11～0.93,P=0.04)；而两组患者术后远期满意度差异无统计学意义(OR=0.98,95％CI:0.61～1.56,P=0.92).结论 腹腔镜Nissen及Toupet手术均为安全有效的手术方式.选择哪种术式可根据患者情况及外科医生自身技术和经验而定.
目的 比較腹腔鏡Nissen手術與Toupet手術在治療胃食管反流病的療效以及術後併髮癥的髮生率.方法 通過Pubmed,Medline,Embase以及Cochrane圖書館數據庫進行文獻檢索,用Nissen,Toupet,fundoplication[ Mesh]為關鍵詞,僅將比較腹腔鏡Nissen以及Toupet兩種手術方式的隨機對照研究納入本研究,分彆統計兩組患者在術後早期(3～6箇月)以及術後晚期(1～3年)的燒心、反痠、吞嚥睏難、胸痛、腹脹、不能打嗝、腹瀉、術後早期併髮癥的髮生率及滿意度等.結果 在納入本研究的7箇隨機對照研究總計939例患者中,腹腔鏡Nissen手術478例,腹腔鏡Toupet手術461例.兩組患者的反流癥狀均得到瞭良好的控製,術後燒心的髮生率差異無統計學意義(OR=1.01,95％CI:0.48～2.13,P=0.97).儘管Toupet組在術後早期及晚期吞嚥睏難的髮生率顯著低于Nissen組(OR=3.34,95％CI:2.22～5.02,P＜0.01),但前者術後早期併髮癥的髮生率顯著高于後者(OR=0.31,95％CI:0.11～0.93,P=0.04)；而兩組患者術後遠期滿意度差異無統計學意義(OR=0.98,95％CI:0.61～1.56,P=0.92).結論 腹腔鏡Nissen及Toupet手術均為安全有效的手術方式.選擇哪種術式可根據患者情況及外科醫生自身技術和經驗而定.
목적 비교복강경Nissen수술여Toupet수술재치료위식관반류병적료효이급술후병발증적발생솔.방법 통과Pubmed,Medline,Embase이급Cochrane도서관수거고진행문헌검색,용Nissen,Toupet,fundoplication[ Mesh]위관건사,부장비교복강경Nissen이급Toupet량충수술방식적수궤대조연구납입본연구,분별통계량조환자재술후조기(3～6개월)이급술후만기(1～3년)적소심、반산、탄인곤난、흉통、복창、불능타격、복사、술후조기병발증적발생솔급만의도등.결과 재납입본연구적7개수궤대조연구총계939례환자중,복강경Nissen수술478례,복강경Toupet수술461례.량조환자적반류증상균득도료량호적공제,술후소심적발생솔차이무통계학의의(OR=1.01,95％CI:0.48～2.13,P=0.97).진관Toupet조재술후조기급만기탄인곤난적발생솔현저저우Nissen조(OR=3.34,95％CI:2.22～5.02,P＜0.01),단전자술후조기병발증적발생솔현저고우후자(OR=0.31,95％CI:0.11～0.93,P=0.04)；이량조환자술후원기만의도차이무통계학의의(OR=0.98,95％CI:0.61～1.56,P=0.92).결론 복강경Nissen급Toupet수술균위안전유효적수술방식.선택나충술식가근거환자정황급외과의생자신기술화경험이정.
Objective To compare laparoscopic Nissen fundoplication (LNF)and Toupet laparoscopic fundoplication (LTF)with respect to treatment outcomes and postoperative complications.Methods PubMed,Medline,Embase and the Cochrane Library were searched.Only randomized controlled trials (RCTs) comparing laparoscopic Nissen and Toupet fundoplication were included.Outcomes evaluation included occurrences of heartburn,reflux,difficulty swallowing,chest pain,abdominal distention,failure to hiccup,diarrhea,and early complications and degree of patient satisfaction at early (three to six months) and later (one to three years) post-operative periods.Results Of 939 patients in seven RCTs,478 received LNF and 461 received LTF.For both groups,control of reflux was good and occurrence of heartburn was similar (P＞0.05).A lower incidence of postoperative dysphagia for both early and later post-operative periods,but a higher overall complication rate in early post-operative period were observed in the LTF group (P＜0.05).Patient satisfaction was similar (P＞0.05).Conclusions LNF and LTF are both safe and effective.The adoption of procedure should be based on the patient status and surgeon experience.
