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首页> 外文期刊>Archives of surgery. >Surgical reintervention after antireflux surgery for gastroesophageal reflux disease: a prospective cohort study in 130 patients.
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Surgical reintervention after antireflux surgery for gastroesophageal reflux disease: a prospective cohort study in 130 patients.

机译：胃食管反流病抗回流手术后的外科手术再干预：一项针对130名患者的前瞻性队列研究。

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HYPOTHESIS: Surgical reintervention after antireflux surgery for gastroesophageal reflux disease is required in 3% to 6% of patients. The subjective outcome after reintervention has been reported in several studies, but objective results after these subsequent operations have rarely been published. The purpose of this study was to assess the symptomatic and objective outcomes in patients who underwent subsequent operation because of recurrent reflux symptoms or troublesome dysphagia after primary antireflux surgery. DESIGN: Prospective cohort study. SETTING: University medical center. PATIENTS: Between January 1, 1994, and March 31, 2005, 130 patients (mean [SD] age, 48.4 [14.1] years) undergoing surgical reintervention after antireflux surgery for gastroesophageal reflux disease were prospectively studied. MAIN OUTCOME MEASURES: Symptomatic outcome was determined by questionnaires. Esophageal manometry and 24-hour pH monitoring were performed to assess the objective outcome. RESULTS: A total of 144 reinterventions were performed in 130 patients, for recurrent reflux in 94 patients (65.3%) and for troublesome dysphagia in 50 patients (34.7%). Belsey Mark IV fundoplication through a left-sided thoracotomy was performed in 78 (54.2%) and a subsequent Nissen or partial fundoplication during 66 reinterventions (45.8%), including 16 laparoscopic procedures. After a mean (SD) follow-up of 60.1 (37.2) months, symptoms were absent or significantly improved in 70.3% of patients and esophageal acid exposure was normalized in 70.2% of patients after surgery. Postoperative complications occurred after 14 subsequent operations (9.7%). CONCLUSIONS: Surgical reintervention after antireflux surgery for gastroesophageal reflux disease yielded good symptomatic and objective results in 70% of patients in this prospective cohort study. Since the morbidity of this type of surgery is far from negligible, the expectations should be discussed in detail before additional operation.
机译：假设：在3％至6％的患者中，需要进行抗返流手术后进行胃食管反流疾病的手术再干预。几项研究报道了再干预后的主观结果，但这些后续手术后的客观结果很少发表。这项研究的目的是评估因抗反流手术后反复出现反流症状或吞咽困难而进行后续手术的患者的症状和客观结果。设计：前瞻性队列研究。地点：大学医学中心。患者：1994年1月1日至2005年3月31日，对130例胃反流手术后反胃手术的胃食管反流疾病患者（平均[SD]年龄，48.4 [14.1]岁）进行了研究。主要观察指标：对症症状通过问卷调查确定。进行食管测压和24小时pH监测以评估客观结果。结果：130例患者共进行了144例再次介入治疗，其中94例患者（65.3％）出现复发性反流，50例患者（34.7％）发生了吞咽困难。通过左侧胸廓切开术进行的Belsey Mark IV胃底折叠术在78例（54.2％）中进行，随后在66次再次介入（45.8％）的Nissen或部分胃底折叠术中进行，包括16例腹腔镜手术。在平均（SD）随访60.1（37.2）个月后，手术后70.3％的患者症状消失或明显改善，并且70.2％的患者食管酸暴露正常。术后14例术后发生并发症（9.7％）。结论：在这项前瞻性队列研究中，抗反流手术后对胃食管反流疾病的手术再干预在70％的患者中产生了良好的症状和客观结果。由于这种手术的发病率很难忽略，因此在进行其他手术之前应详细讨论预期。

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