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首页> 外文期刊>Surgical Endoscopy >A prospective multicenter study on laparoscopic treatment of gastroesophageal reflux disease in Italy: type of surgery, conversions, complications, and early results. Study Group for the Laparoscopic Treatment of Gastroesophageal Reflux Disease of th
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A prospective multicenter study on laparoscopic treatment of gastroesophageal reflux disease in Italy: type of surgery, conversions, complications, and early results. Study Group for the Laparoscopic Treatment of Gastroesophageal Reflux Disease of th

机译：在意大利进行的腹腔镜治疗胃食管反流疾病的前瞻性多中心研究：手术类型，转换，并发症和早期结果。腹腔镜治疗胃食管反流病研究组

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BACKGROUND: A national survey was undertaken by the Italian Society for Laparoscopic Surgery to investigate the prevalence, indications, conversion rate, mortality, morbidity, and early results of laparoscopic antireflux surgery. METHODS: Beginning on January 1, 1996, all of the centers taking part in this study were asked to complete a questionnaire on each patient. The questionnaire was divided into four parts and covered such areas as indications for surgery and preoperative workup, type of operation performed and certain aspects of the surgical technique, conversions and their causes, intraoperative and postoperative complications (within 4 weeks), and details of the postoperative course. The last part of the questionnaire focused on the follow-up period and was designed to gather data on recurrence of preoperative symptoms, postoperative symptoms (dysphagia, gas bloat), and postoperative test findings. RESULTS: As of June 30, 1998, 21 centers were taking part in the study and 621 patients were enrolled, with a median of 27 patients per center (less than one patient/month). The most popular technique was the Nissen-Rossetti (52%), followed by the Nissen (33%) and Toupet procedures (13%). Other techniques, such as the Dor and Lortat-Jacob, were used in the remainder of cases. Patients who received a Toupet procedure had a higher incidence of defective peristalsis (p<0.05). The conversion rate to open surgery was 2.9%. The most common causes of conversion were inability to reduce the hiatus hernia or distal esophagus in the abdomen and adhesions from previous surgery. Perforation of the stomach and esophagus occurred in <1% of patients. Mortality was nil. Postoperative complications were observed in 7.3% of cases. The most common complication was acute dysphagia (19 patients), which required reoperation in 10 patients. No differences in the incidence of acute dysphagia were found for the different surgical techniques employed. Follow-up data were obtained for 319 patients (53%): 91.5% of the patients remained GERD symptom-free; severe esophagitis (grade 2-3) healed in 95% of the patients; lower esophageal sphincter (LES) manometric characteristics (pressure, abdominal length, and overall length) improved significantly after surgery (p<0.005); and acid exposure of the distal esophagus decreased. CONCLUSIONS: Laparoscopic antireflux surgery has no mortality and a low morbidity. Symptoms and esophagitis are resolved in >90% of patients. Despite these favorable results, however, this type of surgery is not yet as widely employed in Italy as in other countries.
机译：背景：意大利腹腔镜手术学会进行了一项全国性调查，以调查腹腔镜抗反流手术的患病率，适应症，转换率，死亡率，发病率和早期结果。方法：从1996年1月1日开始，要求所有参与该研究的中心填写每位患者的调查表。该调查问卷分为四个部分，涵盖了以下方面：手术和术前检查的适应症，手术类型和手术技术的某些方面，转换及其原因，术中和术后并发症（4周内）以及详细信息。术后过程。问卷的最后一部分集中在随访期间，旨在收集有关术前症状，术后症状（吞咽困难，胃胀气）和术后检查结果复发的数据。结果：截至1998年6月30日，已有21个中心参与该研究，招募621名患者，每个中心的中位数为27名患者（少于一个患者/月）。最受欢迎的技术是Nissen-Rossetti（52％），其次是Nissen（33％）和Toupet程序（13％）。在其他情况下，还使用了其他技术，例如Dor和Lortat-Jacob。接受Toupet手术的患者发生蠕动不良的几率更高（p <0.05）。开腹手术的转化率为2.9％。转换的最常见原因是无法减少腹部裂孔疝或食管远端以及先前手术造成的粘连。少于1％的患者发生胃和食道穿孔。死亡率为零。 7.3％的病例观察到术后并发症。最常见的并发症是急性吞咽困难（19例），需要再手术10例。对于采用的不同手术技术，发现吞咽困难的发生率没有差异。获得了319例患者的随访数据（53％）：91.5％的患者无GERD症状; 95％的患者患有严重的食管炎（2-3级）;术后食管下括约肌（LES）的测压特征（压力，腹部长度和总长度）显着改善（p <0.005）;并且食管远端的酸暴露减少。结论：腹腔镜抗反流手术无死亡率，低发病率。超过90％的患者症状和食道炎得到解决。尽管取得了这些良好的效果，但是，这种手术在意大利的普及程度还不如其他国家。

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