Lundell Lars
Department of Surgery, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
Dig Dis. 2007;25(3):188-96. doi: 10.1159/000103883.
Due to the chronic, relapsing nature of gastroesophageal reflux disease, lifelong therapeutic options have to be considered and recommended in many patients. Accordingly, surgical repair has to be evaluated based on modern, evidence-based methodologies.
A careful review has been carried out of the relevant surgical literature also including trials incorporating direct comparisons between medical and surgical therapies. The outcome of such a survey has been structured according to the grading of evidence from highest grade I to the lowest III.
Grade I evidence exists to show that antireflux surgery is more effective than proton pump inhibition in the control of reflux-related symptoms. Side effects are burdening surgical repair, many of which do not decrease over time. Data are not consistent to show any benefit of surgery whenever health economic outcomes are required. Minor differences are in favor of laparoscopic operations and it does matter who is doing the operation and how the repair is completed. Better data are requested to assess the true long-term efficacy (>10 years) of corresponding operations.
Antireflux surgery is an effective and durable therapeutic modality in the long-term management of gastroesophageal reflux disease.
由于胃食管反流病具有慢性、复发性的特点，许多患者必须考虑并推荐终身治疗方案。因此，必须基于现代循证医学方法对手术修复进行评估。
对相关外科文献进行了仔细回顾，其中也包括对药物治疗和手术治疗进行直接比较的试验。此次调查结果已根据从最高的I级到最低的III级的证据等级进行了整理。
有I级证据表明，抗反流手术在控制反流相关症状方面比质子泵抑制剂更有效。手术修复存在副作用负担，其中许多不会随时间减轻。在需要健康经济结果时，数据并不一致地显示手术有任何益处。微小差异有利于腹腔镜手术，手术操作者以及修复方式也很重要。需要更好的数据来评估相应手术的真正长期疗效（>10年）。
抗反流手术是胃食管反流病长期管理中一种有效且持久的治疗方式。
