Dassinger M S, Torquati A, Houston H L, Holzman M D, Sharp K W, Richards W O
Vanderbilt University, Nashville, Tennessee 37232-2577, USA.
Am Surg. 2004 Aug;70(8):691-4; discussion 694-5.
There are few published reports on outcomes of 5 or more years following laparoscopic fundoplication. Gastroesophageal reflux disease (GERD) specific quality of life questionnaires (QOLRAD), short form health surveys (SF12), and queries regarding current medication use and long-term satisfaction were mailed to all patients who underwent laparoscopic fundoplication at our institution. Results are reported as mean +/- SEM. Seventy-six patients underwent laparoscopic fundoplication (63 Nissen, 13 Toupet) between November 1992 and December 1997. Fifty-two patients completed questionnaires (68%). Mean follow-up was 5.1 +/- 0.2 years (range, 4-9 years). Mean QOLRAD scores were 5.8 +/- 0.2, (scale 0-7, a higher score reflecting improved QOL), which is comparable to the general population (6.0 mean). SF-12 mental and physical scores were 46.6 +/- 1.7 and 34.2 +/- 1.6, respectively, versus 50.7 and 51.2 for the general population. Forty-seven patients (92%) would have the procedure again. Eleven (21%) remained on antisecretory medications (15% proton pump inhibitor and 6% H2 receptor antagonists). None of the 11 patients underwent 24-hour pH testing to document persistent acid exposure. Furthermore, postoperative symptoms of heartburn, dysphagia, and abdominal bloating were rated as none to mild in the majority of patients. Laparoscopic fundoplication is an effective long-term treatment for GERD, resulting in high patient satisfaction, improved quality of life, and elimination of antisecretory medicines in the majority of patients.
关于腹腔镜胃底折叠术5年或更长时间后的治疗结果，已发表的报告较少。我们向在本机构接受腹腔镜胃底折叠术的所有患者邮寄了胃食管反流病（GERD）特异性生活质量问卷（QOLRAD）、简短健康调查问卷（SF12），并询问了当前用药情况和长期满意度。结果以平均值±标准误报告。1992年11月至1997年12月期间，76例患者接受了腹腔镜胃底折叠术（63例nissen术，13例Toupet术）。52例患者完成了问卷调查（68%）。平均随访时间为5.1±0.2年（范围4 - 9年）。QOLRAD平均得分是5.8±0.2（范围0 - 7，分数越高表明生活质量改善），这与普通人群（平均6.0）相当。SF - 12精神和身体得分分别为46.6±1.7和34.2±1.6，而普通人群分别为50.7和51.2。47例患者（92%）愿意再次接受该手术。11例患者（21%）仍在使用抗分泌药物（15%为质子泵抑制剂，6%为H2受体拮抗剂）。这11例患者中没有一人进行24小时pH测试以证实存在持续的酸暴露。此外，大多数患者的烧心、吞咽困难和腹胀等术后症状被评为无至轻度。腹腔镜胃底折叠术是治疗GERD的一种有效的长期治疗方法，能使患者满意度高，生活质量改善，且大多数患者无需使用抗分泌药物。
