Bustorff-Silva J, Fonkalsrud E W, Perez C A, Quintero R, Martin L, Villasenor E, Atkinson J B
Division of Pediatric Surgery, UCLA School of Medicine, Los Angeles, CA 90095-1749, USA.
J Pediatr Surg. 1999 Jan;34(1):79-82; discussion 82-3. doi: 10.1016/s0022-3468(99)90233-6.
Although several centers often perform gastric emptying procedures (GEP) together with fundoplication for gastroesophageal reflux (GER) and delayed gastric emptying (DGE), the benefit of GEP is controversial. The present study addresses the question of whether adding a GEP in children with preoperatively diagnosed GER and DGE affects the recurrence rate of GER after Nissen fundoplication (NF).
A retrospective chart review was performed on all children under the age of 16 years, operated on for GER from 1980 to 1997, who had a preoperative diagnosis of DGE, and at least 6 months of follow-up. Gastric retention of more than 50% of a radiolabeled meal at 90 minutes was considered DGE. Recurrent reflux was defined as reappearance of GER symptoms, confirmed by postoperative esophagram or 24 hours of pH monitoring.
Of the 183 patients with DGE, 92 were available for long-term follow-up. Of these, 20 had no gastric emptying procedure performed (no-GEP group) and 72 had a GEP performed together with an NF (GEP group). Groups were comparable as to age at operation, mean follow-up time, male to female ratio and prevalence of associated anomalies. A higher prevalence of neurological impairment (NI) was present in the GEP group (48.6% v20.0%). Mean preoperative gastric retention was significantly higher in the GEP group (69.9 +/- 1.3%) than in the no-GEP group (61.4 +/- 2.2%). No complications resulted from the GEP. Recurrent reflux rate was 18.1% in the GEP group (13 of 72) versus 35.0% (7 of 20) in the no-GEP group. Actuarial analysis disclosed a marginally significant difference in the rate of recurrent reflux between the groups (P = .057) and estimation of the relative risk showed a 1.94 increase of recurrent reflux risk in the no-GEP (0.89<RR<4.20).
Children with DGE, who did not have GEP, had twice the frequency of recurrent reflux as those who had a GER Preoperative screening for DGE, as well as operative correction of DGE at the time of fundoplication, is therefore recommended.
尽管多个中心常将胃排空程序（GEP）与抗反流手术联合用于治疗胃食管反流（GER）和胃排空延迟（DGE），但GEP的益处仍存在争议。本研究探讨了在术前诊断为GER和DGE的儿童中加做GEP是否会影响尼森胃底折叠术（NF）后GER的复发率。
对1980年至1997年间接受GER手术、术前诊断为DGE且至少随访6个月的所有16岁以下儿童进行回顾性病历审查。90分钟时放射性标记餐胃潴留超过50%被视为DGE。复发性反流定义为GER症状再次出现，经术后食管造影或24小时pH监测证实。
183例DGE患者中，92例可进行长期随访。其中，20例未进行胃排空程序（无GEP组），72例在NF手术时同时进行了GEP（GEP组）。两组在手术年龄、平均随访时间、男女比例及相关畸形患病率方面具有可比性。GEP组神经功能障碍（NI）患病率较高（48.6%对20.0%）。GEP组术前平均胃潴留明显高于无GEP组（69.9±1.3%对61.4±2.2%）。GEP未导致并发症。GEP组复发性反流率为18.1%（72例中的13例），无GEP组为35.0%（20例中的7例）。精算分析显示两组复发性反流率存在边缘性显著差异（P = 0.057），相对风险估计显示无GEP组复发性反流风险增加1.94倍（0.89 < RR < 4.20）。
未进行GEP的DGE儿童复发性反流频率是进行GEP儿童的两倍。因此，建议对DGE进行术前筛查，并在胃底折叠术时对DGE进行手术矫正。
