腹腔镜胃底折叠术能否长期控制胃食管反流相关性咳嗽？
Does laparoscopic fundoplication provide long-term control of gastroesophageal reflux related cough?
作者信息
Allen C J, Anvari M
机构信息
Department of Medicine, St Joseph's Healthcare-McMaster University, 50, Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
出版信息
Surg Endosc. 2004 Apr;18(4):633-7. doi: 10.1007/s00464-003-8821-6. Epub 2004 Mar 19.
BACKGROUND
Of patients with chronic cough, 21% have GERD. Up to half of these patients may not respond adequately to medical, but the long-term results of antireflux surgery for cough is unknown.
METHODS
A total of 905 patients (209 with respiratory symptoms, mainly cough) underwent laparoscopic Nissen fundoplication. Preoperatively patients underwent esophageal motility studies, 24-h pH monitoring, and symptom evaluation using a validated scale. Of eligible patients, 81% were followed at 6 months, 73% at 2 years, and 60% at 5 years.
RESULTS
Before surgery, 83% of respiratory patients (RP) and 51% of nonrespiratory patients (NRP) had cough. RP had higher cough scores ( p < 0.0001), but improvement in cough compared to baseline was similar in the RP and NRP ( p = 0.1105 at 6 months, 0.4206 at 2 years, and 0.1348 at 5 years). Cough improved in 83% at 6 months, 74% at 2 years, and 71% at 5 years.
CONCLUSIONS
Laparoscopic Nissen fundoplication is successful in the long-term control of GERD-related cough, even in patients who fail medical therapy.
背景
在慢性咳嗽患者中，21%患有胃食管反流病（GERD）。这些患者中多达一半可能对药物治疗反应不佳，但抗反流手术治疗咳嗽的长期效果尚不清楚。
方法
共有905例患者（209例有呼吸道症状，主要为咳嗽）接受了腹腔镜下尼森胃底折叠术。术前患者接受食管动力研究、24小时pH监测，并使用经过验证的量表进行症状评估。符合条件的患者中，81%在6个月时接受随访，73%在2年时接受随访，60%在5年时接受随访。
结果
手术前，83%的呼吸道疾病患者（RP）和51%的非呼吸道疾病患者（NRP）有咳嗽症状。RP患者的咳嗽评分更高（p<0.0001），但与基线相比，RP和NRP患者咳嗽症状的改善情况相似（6个月时p=0.1105，2年时p=0.4206，5年时p=0.1348）。6个月时83%的患者咳嗽症状改善，2年时为74%，5年时为71%。
结论
腹腔镜下尼森胃底折叠术在长期控制GERD相关咳嗽方面是成功的，即使是对药物治疗无效的患者。
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