Olberg Petter, Johannessen Rune, Johnsen Gjermund, Myrvold Helge E, Bjerkeset Tormod, Fjösne Ulf, Petersen Hermod
Section of Gastroenterology, Department of Medicine, St Olav's Hospital, Trondheim, Norway.
Scand J Gastroenterol. 2005 Mar;40(3):264-74. doi: 10.1080/00365520510011588.
A recent randomized study has shown that the long-term effects of continuous medical treatment of gastroesophageal reflux disease (GERD) with a proton-pump inhibitor are comparable to those of open fundoplication. We compared the long-term effects of anti-reflux surgery with those of medical care according to clinical practice.
This is a questionnaire-based 3-10 years follow-up study of 373 patients with GERD operated on in two hospitals with either open or laparoscopic fundoplication, and pair-matched non-operated controls treated medically according to clinical practice. The controls were matched for hospital, age, sex, follow-up time, degree of esophagitis, presence of hiatus hernia and Barrett's esophagus. The questionnaires used for symptoms and health-related quality of life (QoL) were the Gastrointestinal Symptoms Rating Scale and the Psychological General Well-Being Index, respectively.
Response rates were about 80%, and 179 pairs of operated patients and controls remained for analysis (102 based on laparoscopic and 77 on open fundoplication). Independently of the surgical technique, the operated patients suffered at the follow-up from significantly (p <0.001) fewer reflux symptoms than the non-operated controls, the mean scores being 1.34 and 2.51, respectively. The operated patients suffered from slightly more symptoms of indigestion (p <0.05). No consistent significant differences between the groups were found for QoL. Significant differences in QoL in favor of the operated patients were found when dealing only with the 43 pairs with no concurrent disease.
The study shows that in our area anti-reflux surgery is more effective in relieving reflux symptoms than medical care according to clinical practice.
最近一项随机研究表明，质子泵抑制剂持续药物治疗胃食管反流病（GERD）的长期效果与开放式胃底折叠术相当。我们根据临床实践比较了抗反流手术与药物治疗的长期效果。
这是一项基于问卷调查的随访研究，对373例在两家医院接受开放式或腹腔镜胃底折叠术的GERD患者，以及根据临床实践接受配对匹配的非手术药物治疗对照组进行了3至10年的随访。对照组在医院、年龄、性别、随访时间、食管炎程度、食管裂孔疝和巴雷特食管的存在情况方面进行了匹配。用于症状和健康相关生活质量（QoL）的问卷分别是胃肠道症状评分量表和心理总体幸福感指数。
回复率约为80%，179对手术患者和对照组可供分析（102例基于腹腔镜手术，77例基于开放式胃底折叠术）。无论手术技术如何，手术患者在随访时的反流症状明显（p<0.001）少于非手术对照组，平均得分分别为1.34和2.51。手术患者的消化不良症状略多（p<0.05）。两组在QoL方面未发现一致的显著差异。仅处理43对无并发疾病的患者时，发现手术患者在QoL方面有显著差异。
该研究表明，在我们地区，抗反流手术在缓解反流症状方面比根据临床实践的药物治疗更有效。
