Fernando Hiran C, Schauer Philip R, Rosenblatt Mo, Wald Arnold, Buenaventura Percy, Ikramuddin Sayeed, Luketich James D
Division of Thoracic Surgery, Minimally Invasive Surgery Center, University of Pittsburgh Medical Center, PA 15213-3221, USA.
J Am Coll Surg. 2002 Jan;194(1):23-7. doi: 10.1016/s1072-7515(01)01110-3.
Gastroesophageal reflux disease significantly affects a patient's quality of life (QOL). Laparoscopic fundoplication offers an alternative to medical therapy, but few studies have compared outcomes. Our objective was to examine QOL scores in gastroesophageal reflux disease patients treated medically and surgically.
We undertook a retrospective analysis of patients undergoing surgical or medical treatment for gastroesophageal reflux disease over a 1-year period (August 1997 to August 1998). Followup QOL was measured using the Short-Form 36, and heartburn severity was measured using the Health Related Quality of Life scale (a disease-specific instrument with a best score of 0 and a worst score of 45).
Laparoscopic fundoplication was undertaken in 120 patients with a median age of 47 years (range 17 to 80 years). The medical cohort included 51 patients selected from the gastroenterology clinic with a median age of 48 years (range 17 to 82 years). Duration of heartburn was not significantly different, with 40 (78.4%) of the 51 medical and 98 (81.7%) of the 120 surgical patients having had symptoms for longer than 12 months. There were no operative deaths. There were 12 complications (esophageal perforation 1, pneumothorax 2, pneumonia 1, pulmonary embolus 3, other/miscellaneous 5). Mean length of stay was 1.6 days, time to oral intake 1.2 days, and return to normal activity 4.2 weeks. Routine followup was available in 118 surgical and 47 medical patients. The medical cohort had increased (p < 0.05) symptoms of heartburn (43% versus 19%), waterbrash (26% versus 8%), and regurgitation (30% versus 8%) and greater requirement for proton pump inhibitors (74% versus 19%) and propulsid (19% versus 3%) over the surgical group. Detailed outcomes were available in 101 surgical and 37 medical patients. Mean (+/-SE) Health Related Quality of Life scores were better (p < 0.05) in the surgical group (4+/-0.6 versus 21+/-1.4). More of the medical patients were dissatisfied (21.6% versus 5.9%). Short-Form 36 scores at followup were better (p < 0.05) in six of eight domains for surgical patients.
Heartburn scores and global QOL scores were superior after laparoscopic fundoplication compared with medical management in this patient population. Laparoscopic fundoplication should be considered for patients who are dissatisfied with medical treatment.
胃食管反流病严重影响患者的生活质量（QOL）。腹腔镜胃底折叠术为药物治疗提供了一种替代方法，但很少有研究比较两者的疗效。我们的目的是研究接受药物治疗和手术治疗的胃食管反流病患者的生活质量评分。
我们对1997年8月至1998年8月期间接受胃食管反流病手术或药物治疗的患者进行了回顾性分析。使用简短健康调查问卷（Short-Form 36）测量随访时的生活质量，使用健康相关生活质量量表（一种特定疾病的工具，最佳得分为0，最差得分为45）测量烧心严重程度。
120例患者接受了腹腔镜胃底折叠术，中位年龄为47岁（范围17至80岁）。药物治疗组包括从胃肠病诊所挑选的51例患者，中位年龄为48岁（范围17至82岁）。烧心持续时间无显著差异，51例药物治疗患者中有40例（78.4%）、120例手术患者中有98例（81.7%）症状持续超过12个月。无手术死亡病例。有12例并发症（食管穿孔1例、气胸2例、肺炎1例、肺栓塞3例、其他/杂项5例）。平均住院时间为1.6天，开始经口进食时间为1.2天，恢复正常活动时间为4.2周。118例手术患者和47例药物治疗患者有常规随访数据。与手术组相比，药物治疗组烧心（43%对19%）、反酸水（26%对8%）和反流（30%对8%）症状增加（p<0.05），对质子泵抑制剂（74%对19%）和西沙必利（19%对3%）的需求更大。101例手术患者和37例药物治疗患者有详细的疗效数据。手术组的平均（±标准误）健康相关生活质量评分更好（p<0.05）（4±0.6对21±1.4）。更多药物治疗患者不满意（21.6%对5.9%）。手术患者随访时简短健康调查问卷在八个领域中的六个领域得分更好（p<0.05）。
在该患者群体中，与药物治疗相比，腹腔镜胃底折叠术后烧心评分和总体生活质量评分更高。对于对药物治疗不满意的患者，应考虑腹腔镜胃底折叠术。
