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腹腔镜下抗反流手术失败后行再次折叠术的长期随访:生活质量、症状转归及患者满意度

Long-term follow-up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome, and patient satisfaction.

作者信息

Granderath Frank A, Kamolz Thomas, Schweiger Ursula M, Pointner Rudolph

机构信息

Department of General Surgery, Hospital Zell am See, A-5700 Zell am See, Austria.

出版信息

J Gastrointest Surg. 2002 Nov-Dec;6(6):812-8. doi: 10.1016/s1091-255x(02)00089-6.

Abstract

Quality of life and patient satisfaction have been shown to be important factors in evaluating outcome of laparoscopic antireflux surgery (LARS). The aim of this study was to evaluate data pertaining to quality of life, patient satisfaction, and changes in symptoms in patients who underwent laparoscopic redo surgery after primary failed open or laparoscopic antireflux surgery 3 to 5 years postoperatively. Between March 1995 and June 1998, a total of 27 patients whose mean age was 57 years (range 35 to 78 years) underwent laparoscopic refundoplication for primary failed open or laparoscopic antireflux surgery. Quality of life was evaluated by means of the Gastrointestinal Quality of Life Index (GIQLI). Additionally, patient satisfaction and symptomatic outcome were evaluated using a standardized questionnaire. Three to 5 years after laparoscopic refundoplication, patients rated their quality of life (GIQLI) in an overall score of 113.4 points. Twenty-five patients (92.6%) rated their satisfaction with the redo procedure as very good and would undergo surgery again, if necessary. These patients were no longer taking any antireflux medication at follow-up. Two patients (7.4%) reported rare episodes of heartburn, which were managed successfully with proton pump inhibitors on demand, and four patients (14.8%) reported some episodes of regurgitation but with no decrease in quality of life. Seven patients (25.9%) suffer from mild-to-moderate dysphagia 5 years postoperatively, and 12 patients (44.4%) report having occasional chest pain but no other symptoms of gastroesophageal reflux disease. Nine of these patients suffer from concomitant cardiopulmonary disease. Laparoscopic refundoplication after primary failed antireflux surgery results in a high degree of patient satisfaction and significant improvement in quality of life with a good symptomatic outcome for a follow-up period of 3 to 5 years after surgery.

摘要

生活质量和患者满意度已被证明是评估腹腔镜抗反流手术(LARS)疗效的重要因素。本研究的目的是评估在初次开放或腹腔镜抗反流手术失败3至5年后接受腹腔镜再次手术的患者的生活质量、患者满意度及症状变化的数据。1995年3月至1998年6月,共有27例平均年龄为57岁(范围35至78岁)的患者因初次开放或腹腔镜抗反流手术失败而接受了腹腔镜再次胃底折叠术。通过胃肠道生活质量指数(GIQLI)评估生活质量。此外,使用标准化问卷评估患者满意度和症状结果。腹腔镜再次胃底折叠术3至5年后,患者对其生活质量(GIQLI)的总体评分为113.4分。25例患者(92.6%)对再次手术的满意度评价为非常好,如有必要愿意再次接受手术。这些患者在随访时不再服用任何抗反流药物。2例患者(7.4%)报告有罕见的烧心发作,按需使用质子泵抑制剂成功控制,4例患者(14.8%)报告有一些反流发作,但生活质量未下降。7例患者(25.9%)术后5年患有轻至中度吞咽困难,12例患者(44.4%)报告偶尔有胸痛,但无其他胃食管反流病症状。其中9例患者患有合并心肺疾病。初次抗反流手术失败后进行腹腔镜再次胃底折叠术可使患者高度满意,生活质量显著改善,术后3至5年的随访期内症状结果良好。

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