目的    总结腹腔镜抗反流手术治疗胃食管反流病的技术操作规范。方法    回顾性分析第二军医大学长征医院普通外科2000-2013年收治的185例胃食管反流病病人的临床资料、手术高清视频及术后饮食方案。结果    185例病人均顺利施行腹腔镜抗反流手术（食管裂孔修补+胃底折叠术），无死亡及中转病例。根据术者经验结合高清视频将腹腔镜抗反流手术分为7个步骤，每个步骤均遵循技术操作要点并寻找到特定的解剖标识（如左右侧膈肌脚、食管裂孔等）；病人术后禁食1 d，逐步将饮食从清流质过渡到正常。结论    注重识别解剖标志、寻找正确的外科平面并按照技术要点操作，是成功施行腹腔镜抗反流手术的关键；规范的术后饮食指导对提高病人手术满意率有一定帮助。

Laparoscopic antireflux surgery for gastroesophageal reflux disease: A clinical analysis of 185 patients                         SHAN Cheng-xiang, ZHANG Wei, JIANG Dao-zhen, et al. Department of General Surgery, Chang Zheng Hospital Affiliated to Second Military Medical University, Shanghai 200003, China
Corresponding author: QIU Ming, E-mail: Qiuming2006@yahoo.cn
Abstract    Objective    To summarize the technical practice of laparoscopic antireflux surgery (LARS) for gastroesophageal reflux disease (GERD). Methods    The clinical data, high-definition LARS videos, and postoperative diet scheme of 185 GERD patients from 2000 to 2013 in Department of General Surgery, Chang Zheng Hospital Affiliated to Second Military Medical University were reviewed retrospectively. Results    Laparoscopic antireflux surgery (hiatal herniorrhaphy plus fundoplication) was all successfully performed in 185 patients with none death and conversion operation. The procedure of LARS was divided into 7 steps according to our experience and HD video, standard surgical rules were followed and specific anatomic landmarks were found in each step, such as diaphragmatic crura and esophageal hiatus. The patients were deprived of food 24 hours after surgery and recovered to normal diet from clear liquid gradually and slowly. Conclusion    Identification of anatomic landmarks and surgical planes, and adherence of technical key points are important to perform LARS successfully. Effective postoperative dietary guidance is helpful to increase satisfaction rate of patients.