Bessell J R, Adair W D, Smithers B M, Martin I, Menzies B, Gotley D C
University of Queensland Department of Surgery, Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia.
Br J Surg. 2002 Jun;89(6):783-6. doi: 10.1046/j.1365-2168.2002.02112.x.
A small number of patients develop acute severe dysphagia for which reoperation is necessary within 10 days of laparoscopic fundoplication. The aim of this study was to identify clinical variables that might predict the likelihood of this condition occurring, such that it could be avoided in the future.
This was a prospective cohort study from three tertiary referral centres, using reoperation for acute dysphagia as the main outcome variable. Gastrointestinal symptom rating scale, and psychological well-being index questionnaires were undertaken before laparoscopic fundoplication, and dysphagia scores were determined before operation and 1 year later. Standard preoperative assessment included gastroscopy, oesophageal manometry and pH studies.
Twelve (1.9 per cent) of the 617 patients suffered acute dysphagia, which was predicted by older age and female sex, and resulted in a longer duration of hospital stay. This condition was not predicted by any other demographic, clinical, investigative or operative variables.
The study did not identify useful criteria by which severe acute dysphagia could be anticipated and thereby avoided following laparoscopic fundoplication.
少数患者在腹腔镜胃底折叠术后10天内出现急性严重吞咽困难，需要再次手术。本研究的目的是确定可能预测这种情况发生可能性的临床变量，以便将来能够避免。
这是一项来自三个三级转诊中心的前瞻性队列研究，将因急性吞咽困难进行再次手术作为主要结局变量。在腹腔镜胃底折叠术前进行胃肠道症状评分量表和心理健康指数问卷调查，并在手术前和术后1年测定吞咽困难评分。标准的术前评估包括胃镜检查、食管测压和pH值研究。
617例患者中有12例（1.9%）出现急性吞咽困难，其预测因素为年龄较大和女性，且住院时间较长。其他任何人口统计学、临床、检查或手术变量均不能预测这种情况。
该研究未确定有用的标准来预测严重急性吞咽困难，从而在腹腔镜胃底折叠术后避免这种情况。
