Trus T L, Laycock W S, Waring J P, Branum G D, Hunter J G
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
Ann Surg. 1999 Mar;229(3):331-6. doi: 10.1097/00000658-199903000-00005.
To determine if patients with gastroesophageal reflux "well controlled medically" had a different quality of life from those with residual symptoms receiving aggressive medical therapy, and to determine whether laparoscopic antireflux surgery significantly altered quality of life in patients with gastroesophageal reflux.
Clinical determinants of outcome may not adequately reflect the full impact of therapy. The medical outcomes study short form (SF-36) is a well-validated questionnaire that assays eight specific health concepts in three general fields. It may provide a more sensitive tool for judging the success of antireflux therapy.
A total of 345 patients undergoing laparoscopic antireflux surgery completed at least one questionnaire during the study period. Preoperative questionnaires were completed by 290 patients, 223 completed a questionnaire 6 weeks after surgery, and 50 completed the same questionnaire 1 year after surgery. A subgroup of 70 patients was divided before surgery into two groups on the basis of their response to standard medical therapy.
Preoperative scores were extremely low. All eight SF-36 health categories improved significantly 6 weeks and 1 year after surgery. In the 70-patient subgroup, 53 patients (76%) underwent laparoscopic antireflux surgery because of symptoms refractory to medical therapy and 17 patients (24%) reported that their symptoms were well controlled but elected to have surgery because they wished to be medication-free. The preoperative quality of life scores of these two patient groups were equivalent in all but one category. Postoperative scores were significantly improved in all categories and indistinguishable between the two groups.
Laparoscopic antireflux surgery is an effective therapy for patients with gastroesophageal reflux and may be more effective than medical therapy at improving quality of life.
确定药物治疗“控制良好”的胃食管反流患者与接受积极药物治疗但仍有残余症状的患者的生活质量是否存在差异，并确定腹腔镜抗反流手术是否能显著改变胃食管反流患者的生活质量。
治疗结果的临床决定因素可能无法充分反映治疗的全面影响。医学结局研究简表（SF - 36）是一种经过充分验证的问卷，可在三个一般领域中测定八个特定的健康概念。它可能为判断抗反流治疗的成功提供更敏感的工具。
共有345例接受腹腔镜抗反流手术的患者在研究期间完成了至少一份问卷。290例患者完成了术前问卷，223例在术后6周完成了问卷，50例在术后1年完成了相同问卷。70例患者的亚组在手术前根据对标准药物治疗的反应分为两组。
术前评分极低。术后6周和1年，所有八个SF - 36健康类别均有显著改善。在70例患者的亚组中，53例（76%）因药物治疗难治性症状而接受腹腔镜抗反流手术，17例（24%）报告其症状得到良好控制，但因希望停用药物而选择手术。这两组患者术前生活质量评分除一个类别外均相当。术后所有类别评分均显著改善，两组之间无差异。
腹腔镜抗反流手术是治疗胃食管反流患者的有效方法，在改善生活质量方面可能比药物治疗更有效。
