Novitsky Y W, Zawacki J K, Irwin R S, French C T, Hussey V M, Callery M P
Department of Surgery, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
Surg Endosc. 2002 Apr;16(4):567-71. doi: 10.1007/s00464-001-8328-y. Epub 2002 Jan 17.
Gastroesophageal reflux disease (GERD) can be overlooked as the cause of chronic cough (CC) when typical gastrointestinal symptoms are absent or minimal. We analyzed the outcomes of Nissen fundoplication (NF) for patients who failed medical therapy for CC attributable only to GERD (G-CC). We performed a prospective outcome evaluation of 21 consecutive patients with G-CC undergoing NF from 1997 to 2000 at a tertiary care university hospital.
Twenty-one patients without prior antireflux surgeries had G-CC diagnosed by a clinical profile and 24-h pH monitoring showing a cough-reflux correlation. Respiratory symptoms alone were present in 53% of patients. NF was performed when G-CC persisted despite intensive medical therapy, including an antireflux diet. Preoperatively, all patients underwent 24-h pH monitoring, esophageal manometry, barium swallow, gastric emptying study, bronchoscopy, and upper endoscopy. NF was utilized in all cases, laparoscopically in 18. Before and after surgery, patients graded their cough severity using the Adverse Cough Outcome Survey (ACOS). Quality of life was measured using the Sickness Impact Profile (SIP).
Postoperatively, 18 patients (86%) reported an improvement of their cough. G-CC considerably improved in 16/21 patients (76%), with complete resolution in 13 patients (62%). Mild to moderate improvement was found in 2 patients (10%). Patient-reported cough severity (ACOS) and quality of life (SIP) both significantly improved early (6-12 weeks) postoperatively and persisted during the long-term (1 year) follow-up. The average hospital length of stay was 1.78 +/- 0.2 (l-4) days for the laparoscopic (n = 18) and 6.3 +/- 1.2 (4-8) days for the open surgery (n = 3) groups.
Twenty-four-hour esophageal pH monitoring is a valuable tool for preoperative cough-reflux correlation. Antireflux surgery is effective in carefully selected patients whose refractory CC is attributable only to GERD. NF controls the severity of cough while improving the quality of life. Outcomes are further enhanced using laparoscopic procedures with shorter hospital stays.
当典型的胃肠道症状不存在或很轻微时，胃食管反流病（GERD）可能被忽视作为慢性咳嗽（CC）的病因。我们分析了仅因GERD导致的CC（G-CC）患者接受内科治疗失败后行nissen胃底折叠术（NF）的结果。我们对1997年至2000年在一家三级大学医院连续接受NF的21例G-CC患者进行了前瞻性结果评估。
21例未曾接受过抗反流手术的患者，根据临床表现和24小时pH监测显示咳嗽与反流相关而诊断为G-CC。53%的患者仅出现呼吸道症状。尽管进行了强化内科治疗，包括抗反流饮食，但G-CC持续存在时行NF。术前，所有患者均接受24小时pH监测、食管测压、吞钡检查、胃排空研究、支气管镜检查和上消化道内镜检查。所有病例均采用NF，18例采用腹腔镜手术。手术前后，患者使用不良咳嗽结果调查（ACOS）对咳嗽严重程度进行分级。使用疾病影响量表（SIP）测量生活质量。
术后，18例患者（86%）报告咳嗽有所改善。16/21例患者（76%）的G-CC有显著改善，13例患者（62%）完全缓解。2例患者（10%）有轻度至中度改善。患者报告的咳嗽严重程度（ACOS）和生活质量（SIP）在术后早期（6-12周）均有显著改善，并在长期（1年）随访中持续存在。腹腔镜手术组（n = 18）的平均住院时间为1.78 +/- 0.2（1-4）天，开放手术组（n = 3）为6.3 +/- 1.2（4-8）天。
24小时食管pH监测是术前咳嗽与反流相关性的重要工具。抗反流手术对精心挑选的难治性CC仅由GERD引起的患者有效。NF可控制咳嗽严重程度，同时改善生活质量。使用腹腔镜手术可进一步提高疗效，缩短住院时间。
