摘要
目的:评价腹腔镜Nissen胃底折叠术(laparoscopic Nissen fundoplication,LNF)治疗胃食管返流病的长期效果。方法:从MEDLINE、EMBASE、中国生物医学数据库(CBM)及Cochrane试验注册中心检索纳入了1991年到2007年10月发表的LNF治疗返流性食管炎的随机对照实验,并对纳入研究的方法学质量(随机方法、分配隐藏、盲法)进行评价,最后用Rev-Man4.2.9软件进行分析。结果:纳入4个随机对照实验(RCT),包括440例患者,纳入随访研究共387例。术后主观结果如满意度[OR0.5095%CI(0.25,1.00)]、术后抑酸药物的使用[OR0.4595%CI(0.08,2.53)]、返酸和烧心症状差异无统计学意义,吞咽困难LNF发生率高于传统胃底折叠术(conventional Nissen fundoplicationm,CNF)[OR4.1695%CI(1.51,11.50)]。客观结果如再手术率[OR1.7795%CI0.78,4.72)]、食管测压和24h pH检测两组间差异无统计学意义。结论:本研究中LNF治疗胃食管返流病的长期效果和传统胃底折叠术差异无统计学意义,但LNF术后吞咽困难发生率可能较高。
Objective：To evaluate the long-term outcomes of laparoscopic Nissen fundoplieation （LNF） for gastroesophageal reflux disease（GERD）. Methods：We searched randomized controlled trials （RCTs） about LNF for GERD published in MEDLINE, EMBASE ,The Chinese Biomedical Database（CBM） and Cochrane Central Register from 1991 to Oct. 2007. We also evaluated the methodological quality of included studies that involved randomization, allocation concealment, blind method. Meta-analysis was performed with Revman 4.2.9 software. Results ： Four RCTs involving 440 patients were selected, and 387 patients were involved in the following process. Compared to conventional Nissen fundoplication（CNF）, there was not significant difference in the subjective results, such as satisfaction after operation [ OR 0.50 95% CI （0.25,1.00） ], use of acid suppression medications [ OR 0.45 95% CI （0.08 to 2.53） ] ,heartburn and regurgitation. But the incidence of dysphagia in LNF was higher than that in CNF [ OR 4.16 95% CI （ 1.51, 11.50） 1- There was no significant difference in objective results between 2 groups, such as reoperation [ OR 1.77 95% CI （0.78, 4. 72） ] , oesophageal manometry and 24h pH monitoring. Conclusions：The difference of long-term outcomes between LNF and CNF for GERD is not significant,but the incidence of postoperative dysphagia in LNF may be higher than that in CNF.
出处
《腹腔镜外科杂志》
2009年第9期654-659,共6页
Journal of Laparoscopic Surgery
关键词
胃食管返流
腹腔镜术
胃底折叠术
系统评价
Gastroesophageal reflux
Laparoseopy
Fundoplication
System evaluation
