Duffy John P, Maggard Melinda, Hiyama Darryl T, Atkinson James B, McFadden David W, Ko Clifford Y, Hines Oscar J
Department of Surgery, UCLA Medical Center, Los Angeles, California 90095-6904, USA.
Am Surg. 2003 Oct;69(10):833-8.
Laparoscopic Nissen fundoplication has been shown to improve overall quality of life (QOL) in patients with gastroesophageal reflux, but most studies have not addressed patients with atypical symptoms. We investigated the effect of laparoscopic Nissen fundoplication on QOL using the Gastrointestinal Quality of Life Index (GIQLI) survey modified to address both typical (heartburn, regurgitation, dysphagia) and atypical (hoarse voice, chronic cough, adult-onset asthma, vocal cord polyps) symptoms. One-hundred forty-eight patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) at UCLA Medical Center from January 1, 1995 to May 1, 2002. Surveys evaluating pre- and postoperative QOL were administered after surgery: 55 per cent of patients responded (82/148). Forty-eight per cent of all patients (72/148) had atypical symptoms. Perioperative morbidity and mortality were 8.8 per cent and 0.7 per cent, respectively. Mean length of postoperative stay was 2.96 +/- 1.5 days. Mean follow-up for the entire cohort was 18.5 months. Postoperative dysphagia not present before surgery occurred in 4.7 per cent of patients. Eighty per cent of patients were medication-free following surgery. QOL scores for all participants increased significantly from 52.5 +/- 15.3 preoperatively to 72.0 +/- 14.9 postoperatively (P < 0.0001). Patients with atypical symptoms or typical symptoms alone showed significant mean QOL score increases from 48.3 +/- 17.6 preoperatively to 71 +/- 15.7 postoperatively (P < 0.0001) and from 55.7 +/- 12.6 to 72.8 +/- 14.4 (P < 0.0001), respectively. Laparoscopic Nissen fundoplication can effectively improve overall QOL for patients with GERD. Patients with atypical GERD symptoms can experience increases in QOL similar to those with only typical gastrointestinal symptoms.
腹腔镜下尼氏胃底折叠术已被证明可改善胃食管反流患者的整体生活质量（QOL），但大多数研究并未涉及有非典型症状的患者。我们使用经修改以涵盖典型（烧心、反流、吞咽困难）和非典型（声音嘶哑、慢性咳嗽、成人起病的哮喘、声带息肉）症状的胃肠道生活质量指数（GIQLI）调查，研究了腹腔镜下尼氏胃底折叠术对生活质量的影响。1995年1月1日至2002年5月1日期间，148例患者在加州大学洛杉矶分校医学中心接受了腹腔镜下尼氏胃底折叠术治疗胃食管反流病（GERD）。术后进行了评估术前和术后生活质量的调查：55%的患者做出了回应（82/148）。所有患者中有48%（72/148）有非典型症状。围手术期发病率和死亡率分别为8.8%和0.7%。术后平均住院时间为2.96±1.5天。整个队列的平均随访时间为18.5个月。4.7%的患者术后出现术前未有的吞咽困难。80%的患者术后无需用药。所有参与者的生活质量评分从术前的52.5±15.3显著提高到术后的72.0±14.9（P<0.0001）。有非典型症状或仅有典型症状的患者，其生活质量评分均值分别从术前的48.3±17.6显著提高到术后的71±15.7（P<0.0001）和从55.7±12.6提高到72.8±14.4（P<0.0001）。腹腔镜下尼氏胃底折叠术可有效改善GERD患者的整体生活质量。有非典型GERD症状的患者生活质量的提高幅度与仅有典型胃肠道症状的患者相似。
