目的    对比分析老年胃食管反流病（GERD）病人行腹腔镜前180?胃底折叠术和Nissen胃底折叠术两种治疗方法的临床效果。 方法    2008年7月至2012年6月天津市南开医院收治老年GERD 78例，随机分成2组（每组39例），分别行腹腔镜前180?胃底折叠术和Nissen 胃底折叠术治疗，记录2组围手术期相关指标及随访情况，分析2组病人的治疗效果。 结果    78例均通过腹腔镜完成手术，前180?组较Nissen组手术时间短（P<0.05），但术后住院时间差异无统计学意义（P>0.05）。两组术后早期症状均获得缓解，术后1个月复查胃镜、上消化道造影、食管下段压力及24 h pH值监测评分均恢复正常。76例获得随访，1例失访，1例术后10个月死于心肌梗死。随访时间6~54个月，平均28.5个月。两组复发率及病人满意度差异无统计学意义，前180?组较Nissen组术后吞咽困难发生率低，上腹胀气程度轻。 结论    针对老年GERD病人，腹腔镜前180?胃底折叠术和Nissen 胃底折叠术同样具有良好疗效，但前180?胃底折叠术手术时间短，术后吞咽困难和上腹胀气发生率低于Nissen组，GERD老年病人更适宜行前180?胃底折叠术。

Laparoscopic anterior 180° partial fundoplication versus Nissen fundoplication in elderly patients with gastroesophageal reflux disease：A randomized controlled trial        ZHAO Hong-zhi, QIN Ming-fang. Center of Tianjin Minimally Invasive Surgery, Nankai Hospital, Tianjin 300100, China
Corresponding  author ：ZHAO Hong-zhi,  E-mail：tjzhhzh@sina.com
Abstract    Objective    To compare two anti-reflux procedures（laparoscopic anterior 180° partial fundoplication and Nissen fundoplication）in elderly patients with gastroesophageal reflux disease (GERD). Methods    From July 2008 to June 2012, 78 elderly patients with GERD were admitted in Tianjin Nankai Hospital. All the patients were allocated into two groups randomly. Thirty-nine patients were performed laparoscopic anterior 180° partial fundoplication (anterior 180° group) and the other 39 patients were performed Nissen fundoplication (Nissen group). Perioperative clinical parameters were recorded for comparing efficacy between two groups. Results    Laparoscopic surgery was accomplished in all patients. The mean operation time of anterior180° group was significantly less than that of Nissen group (P<0.05). There was no significant difference of the mean duration of postoperative hospital stay between two groups (P>0.05). The symptoms in most patients were adequately relieved after operation. Endoscopy, radiology, esophageal manometry and 24-hour pH monitoring were repeated 1 month after surgery. All the results returned to normal compared with preoperative data. A total of 76 patients got follow-up. One patient was lost. One patient died of heart infarction. During follow-up period of 6-54 months (mean 28.5 months), there was no statistical significance between groups for the recurrence rate and satisfaction rate of operation. There was a lower incidence of dysphagia and epigastric bloating in the anterior 180° group. Conclusion    For elderly patients with GERD，laparoscopic anterior 180°partial fundoplication has a good and durable anti-reflux effect compared with laparoscopic Nissen fundoplication. With shorter operation time and lower incidence of postoperative complications (dysphagia and epigastric bloating) compared with Nissen fundoplication, laparoscopic anterior 180°partial fundoplication can be employed as a more appropriate procedure for treatment of GERD in elderly patients.