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首页> 外文期刊>Surgical Endoscopy >Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease. Long-term quality-of-life assessment and surgical outcome.
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Laparoscopic Nissen fundoplication in patients with nonerosive reflux disease. Long-term quality-of-life assessment and surgical outcome.

机译：非侵蚀性反流病患者的腹腔镜尼森胃底折叠术。长期生活质量评估和手术结果。

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BACKGROUND: It is known that laparoscopic antireflux surgery (LARS) can achieve an excellent surgical outcome including quality of life improvement in patients with erosive gastroesophageal reflux disease (GERD; EGD-positive). Less is known about the long-term surgical outcome in GERD patients who have no evidence of esophagitis (EGD-negative) before surgery. The aim of this study was to evaluate the surgical outcome in a well-selected group of EGD-negative patients compared to that of EGD-positive patients. METHODS: From a large sample of more than 500 patients who underwent LARS, 89 EGD-negative patients (mean age, 51 +/- 6 years; 56 males) were treated surgically because of persistent reflux-related symptoms despite medical therapy. In all cases, preoperative 24-h pH monitoring showed pathological values. To perform a comparative analysis, a matched sample of EGD-positive patients (mean age, 54 +/- 10 years; 58 males) was selected from the database. Surgical outcome included for all patients objective data (e.g., manometry and pH data and endoscopy), quality of life evaluation [Gastrointestinal Quality of Life Index (GIQLI)] symptom evaluation, as well as patients' satisfaction with surgery. The data of a complete 5-year follow-up are available. RESULTS: There were no significant differences in symptomatic improvement, percentage of persistent surgical side-effects, or objective parameters. In general, patients' satisfaction with surgery was comparable in both groups: 95% rated long-term outcome as excellent or good and would undergo surgical treatment again if necessary, respectively. Quality of life improvement was significantly better (p < 0.05) in the EGD-negative group because of the fact that GIQLI was more impaired before surgery (preoperative GIQLI, 81.7 +/- 11.6 points/EGD-negative vs 93.8 +/- 10.3 points/EGD-positive). Five years after surgery, GIQLI in both groups (121.2 +/- 8.5 for EGD-negative vs 120.9 +/- 7.3 for EGD-positive) showed comparable values to healthy controls (122.6 +/- 8.5). CONCLUSION: We suggest that LARS is an excellent treatment option for well-selected patients with persistent GERD-related symptoms who have no endoscopic evidence of esophagitis.
机译：背景：众所周知，腹腔镜抗反流手术（LARS）可以取得出色的手术效果，包括改善胃食管反流性疾病（GERD; EGD阳性）患者的生活质量。对于术前无食管炎（EGD阴性）证据的GERD患者的长期手术结局知之甚少。这项研究的目的是评估与EGD阳性患者相比，精选的一组EGD阴性患者的手术结局。方法：从大量接受LARS治疗的500多例患者中，尽管进行了药物治疗，但由于持续存在与反流有关的症状，对89例EGD阴性患者（平均年龄51 +/- 6岁; 56例男性）进行了手术治疗。在所有情况下，术前24小时pH监测均显示病理值。为了进行比较分析，从数据库中选择了匹配的EGD阳性患者样本（平均年龄，54 +/- 10岁; 58例男性）。手术结局包括所有患者的客观数据（例如测压和pH数据以及内窥镜检查），生活质量评估[胃肠道生活质量指数（GIQLI）]症状评估以及患者对手术的满意度。可以提供完整的5年随访数据。结果：症状改善，持续手术副作用百分比或客观指标无显着差异。总体而言，两组患者对手术的满意度均相当：95％的患者将长期预后评定为良好或良好，必要时将再次接受手术治疗。 EGD阴性组的生活质量改善显着更好（p <0.05），因为GIQLI术前受损更大（术前GIQLI分别为81.7 +/- 11.6点/ EGD阴性vs 93.8 +/- 10.3点/ EGD阳性）。手术五年后，两组的GIQLI（EGD阴性的为121.2 +/- 8.5，EGD阳性的为120.9 +/- 7.3）显示与健康对照组相当的值（122.6 +/- 8.5）。结论：对于没有内镜检查证据的食管炎证据的，持续存在GERD相关症状的精选患者，我们建议LARS是一种极好的治疗选择。

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