基于抗反流屏障Nissen胃底折叠术的演变和评价
| 作 者：邓子泉, 严芝强 |
| 单 位：贵州医科大学 |
| 基金项目： |
| 摘 要： |
| 胃食管反流病（GERD）发生的主要原因为抗反流屏障功能缺陷。1956年问世的Nissen胃底折叠术是治疗GERD的经典外科术式，但传统360°全周包裹易形成超生理“高压区”，导致术后并发症高发，长期影响患者生活质量。围绕生理性抗反流屏障重建这一核心目标，传统Nissen胃底折叠术经过不断改良，衍生出Toupet胃底折叠术、Dor胃底折叠术、短松Nissen胃底折叠术、其他改良Nissen胃底折叠术等术式，旨在平衡抗反流疗效与术后生理功能保留。近年来，内镜下功能性管腔成像探针（EndoFLIP）用于评估食管胃结合部扩张性和顺应性，为胃底折叠术的精准化、个体化提供客观依据。本文就基于抗反流屏障Nissen胃底折叠术的演变和评价作一综述，从生理性抗反流屏障的解剖和功能特点出发，系统梳理各种胃底折叠术式的演变历程、疗效和并发症情况，并结合EndoFLIP技术对其进行评价，为临床术式选择和精准抗反流手术提供参考。 |
| 关键词：胃食管反流病； 胃底折叠术； 抗反流屏障； 抗反流手术 |
Evolution and Assessment of Nissen Fundoplication Based on Anti-reflux Barrier
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| Abstract: |
| Gastroesophageal reflux disease (GERD) is mainly caused by dysfunction of the anti-reflux barrier. First introduced in 1956, Nissen fundoplication is a classic surgical procedure for GERD. However, the traditional 360° total wrap tends to create a supraphysiological high-pressure zone, leading to a high incidence of postoperative complications and impairing long-term quality of life. Centered on the core goal of reconstructing the physiological anti-reflux barrier, the conventional Nissen fundoplication has been continuously modified, giving rise to several procedures including Toupet fundoplication, Dor fundoplication, floppy Nissen fundoplication, and other modified Nissen fundoplication techniques. These modifications aim to balance anti-reflux efficacy and preservation of postoperative physiological functions. Recently, the endoluminal functional lumen imaging probe (EndoFLIP) has been applied to evaluate distensibility and compliance of the esophagogastric junction, providing an objective basis for precise and individualized fundoplication. This article reviewed the evolution and assessment of Nissen fundoplication based on anti-reflux barrier. Based on the anatomy and function of the physiological anti-reflux barrier, the evolution, efficacy and complication profiles of various modified techniques were systematically examined, and a comprehensive evaluation integrated with EndoFLIP technology was provided, so as to offer references for clinical procedure selection and precise anti-reflux surgery. |
| Keywords: Gastroesophageal Reflux Disease; Fundoplication; Anti-Reflux Barrier; Anti-Reflux Surgery |
| 投稿时间：2026-03-05 |
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