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首页> 外文期刊>Surgical Endoscopy >Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia.
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Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia.

机译：腹腔镜胃底折叠术治疗胃食管反流病和食管旁疝的结果。

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BACKGROUND: Laparoscopic fundoplication has become the standard for operative treatment of gastroesophageal reflux disease (GERD). METHODS: We reviewed our experience with 1,000 consecutive patients receiving laparoscopic fundoplication for GERD (n = 882) or paraesophageal hernia (n = 118) between October 1991 and July 1999. Patients with achalasia and failed fundoplication were excluded from analysis. All the patients were evaluated preoperatively by upper endoscopy, esophageal manometry, and barium swallow. After 1994, 24-h pH monitoring was performed selectively in patients with extraesophageal symptoms and/or those without erosive esophagitis. There were 490 men 510 women in this review. Their mean age was 49 years. Procedures performed were 360 degrees floppy fundoplication (n = 879), 360 degrees fundoplication without fundus mobilization (Rossetti) (n = 22), 270 degrees posterior fundoplication (n = 96), and anterior fundoplication (n = 2). Esophageal lengthening procedure (Collis gastroplasty) was performed in combination with fundoplication in 15 patients. In seven patients the treatment was converted to open fundoplication. Outcomes: The average length of hospitalization was 2.2 days, and 136 patients stayed longer than 2 days. Major complications occurred in 21 patients: esophageal perforation (n= 10), acute paraesophageal herniation (n = 4), splenic bleeding (n = 2), cardiac arrest (n = 1), pneumonia (n = 3), and testicular abscess (n = 1). Additional operations were required to manage the complications in 14 patients (70%): Four of these procedures were performed emergently, and 10 patients underwent reoperation between 6 h and 10 days. There were three deaths, all of which involved elderly patients with paraesophageal hernia. There were 35 late failures requiring reoperation for recurrence of GERD or development of new symptoms: The treatment of 32 patients was revised laparoscopically, and 4 patients required laparotomy. Beyond 1 year (median follow-up period, 27 months), 94% of the reviewed patients were satisfied with their surgical outcome.
机译：背景：腹腔镜胃底折叠术已成为胃食管反流病（GERD）手术治疗的标准。方法：我们回顾了我们在1991年10月至1999年7月期间接受腹腔镜胃底折叠术治疗GERD（n = 882）或食管旁疝（n = 118）的1,000例患者的经验。分析不包括门失弛缓和胃底折叠术失败的患者。所有患者术前均接受上镜检查，食管测压和钡餐检查。 1994年以后，对有食管外症状和/或无糜烂性食管炎的患者选择性进行24小时pH监测。在这篇评论中有490名男性510名女性。他们的平均年龄是49岁。所进行的程序为360度软盘胃底折叠术（n = 879），不进行眼底动员的360度胃底折叠术（Rossetti）（n = 22），270度后眼底折叠术（n = 96）和前眼底折叠术（n = 2）。食管延长术（Collis胃成形术）结合胃底折叠术治疗了15例患者。在七名患者中，治疗被转换为开放胃底折叠术。结果：平均住院时间为2.2天，有136例患者住院时间超过2天。主要并发症发生在21例患者中：食管穿孔（n = 10），急性食管旁疝（n = 4），脾出血（n = 2），心脏骤停（n = 1），肺炎（n = 3）和睾丸脓肿（n = 1）。需要额外的手术来控制14例患者（70％）的并发症：其中4例紧急发生，10例患者在6小时至10天之间接受了再次手术。有3例死亡，均涉及食管旁食管疝的老年患者。有35例因GERD复发或出现新症状而需要再次手术的晚期失败：腹腔镜对32例患者进行了治疗修改，而4例患者需要进行剖腹手术。超过1年（中位随访期27个月）后，有94％的复查患者对其手术结果感到满意。

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