CAJ | 학술논문

目的：探讨腹腔镜 Nissen 胃底折叠术治疗胃食管反流病的安全性及临床效果。方法对84例胃食管反流病患者行腹腔镜 Nissen 胃底折叠术，合并食管裂孔疝患者行 Nissen 胃底折叠术的同时行疝修补术。结果84例患者均成功实施腹腔镜 Nissen 胃底折叠术，无中转开腹，无严重并发症及死亡病例。手术时间55～250 min，平均96．4 min，术中出血量20～420ml，平均60．6 ml，术后住院时间5～12 d，平均8．7 d。84例患者术后随访1～24个月，平均15个月。84例患者于术后3个月行24小时食管 pH 值监测与食管测压，DeMeester 评分由87．35±2．81降低到8．72±4．15（P ＜0．05），食管下段括约肌压力由（6．58±2．97）mmHg 上升到（21．27±5．74）mmHg，均较术前明显改善。术后6个月80例烧心、反酸、胸痛等症状完全消失，无需口服 PPI 制剂者，4例经口服PPI 制剂2个月后停药症状缓解。其中16例伴随夜间睡眠时呛咳均获缓解。32例术后有吞咽梗阻感，经饮食训练4～6周后症状消失。结论腹腔镜 Nissen 胃底折叠术是治疗胃食管反流病一种有效、安全、微创的方法，值得临床广泛推广。
목적：탐토복강경 Nissen 위저절첩술치료위식관반류병적안전성급림상효과。방법대84례위식관반류병환자행복강경 Nissen 위저절첩술，합병식관렬공산환자행 Nissen 위저절첩술적동시행산수보술。결과84례환자균성공실시복강경 Nissen 위저절첩술，무중전개복，무엄중병발증급사망병례。수술시간55～250 min，평균96．4 min，술중출혈량20～420ml，평균60．6 ml，술후주원시간5～12 d，평균8．7 d。84례환자술후수방1～24개월，평균15개월。84례환자우술후3개월행24소시식관 pH 치감측여식관측압，DeMeester 평분유87．35±2．81강저도8．72±4．15（P ＜0．05），식관하단괄약기압력유（6．58±2．97）mmHg 상승도（21．27±5．74）mmHg，균교술전명현개선。술후6개월80례소심、반산、흉통등증상완전소실，무수구복 PPI 제제자，4례경구복PPI 제제2개월후정약증상완해。기중16례반수야간수면시창해균획완해。32례술후유탄인경조감，경음식훈련4～6주후증상소실。결론복강경 Nissen 위저절첩술시치료위식관반류병일충유효、안전、미창적방법，치득림상엄범추엄。
Objective To observe the safety and efficacy of laparoscopic Nissen fundoplication in the treatment of gastroesophageal reflux disease(GERD).Methods A total of 84 patients with GERD un-derwent laparoscopic Nissen fundoplication.Patients complicated with esophageal hiatal hernia underwent additional herniorrhaphy at the same time.Results The operations were successfully performed in all ca-ses without conversion to open surgery,severe postoperative complications or death.Operation time ranged from 55 to 250 minutes,with an average of 96.4 minutes.And intraoperative blood loss was ranged from 20 to 420 ml,with an average of 60.6 ml.Patients discharged from hospital in 5 to 12 days,with an average of 8.7 days.All patients were followed-up for 1 month to 2 years,with an average of 15 months.At the 3rd month after operation,all patients received a review of 24-hour esophageal pH monitoring and esophageal pressure monitoring.The DeMeester score was significantly decreased from(87.35 ±2.81)to(8.72 ±4. 15),and the pressure of the lower esophageal sphincter rose from(6.58 ±2.97)mmHg to(21.27 ±5.74) mmHg,which was also improved obviously.At the 6th month after operation,heartburn,acid reflux and chest pain were completely disappeared in 80 cases,without any oral PPI formulation.The other four pa-tients'symptoms were relieved after oral PPI therapy for 2 months.Nighttime choking was relieved in 16 ca-ses.Postoperative dysphagia appeared in 32 cases and the symptoms disappeared by diet training for 4-6 weeks.Conclusion Laparoscopic Nissen fundoplication is a safe,effective and minimally invasive proce-dure in the treatment of gastroesophageal reflux disease,which is worth of spreading.