Ngerncham Monawat, Barnhart Douglas C, Haricharan Ramanath N, Roseman Jeffrey M, Georgeson Keith E, Harmon Carroll M
Department of Epidemiology and International Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
J Pediatr Surg. 2007 Sep;42(9):1478-85. doi: 10.1016/j.jpedsurg.2007.04.002.
BACKGROUND/PURPOSE: Recurrent gastroesophageal reflux disease (rGERD) is a common problem after fundoplication. Previous studies attempting to identify risk factors for rGERD have failed to control for confounding variables. The purpose of this study was to identify significant risk factors for rGERD after controlling for potential confounding variables.
A retrospective, matched case-control study was conducted at a tertiary children's hospital. Cases (n = 116) met 1 of these criteria: reoperation for rGERD, symptomatic rGERD (confirmed by upper gastrointestinal series, esophagogastroduodenoscopy, or pH monitoring), or postoperative reinstitution of antireflux medication for more than 8 weeks. Controls (n = 209) were matched for surgeon, approach (laparoscopic/open), technique (partial/complete), and approximate operative date. Univariate and multivariable associations were analyzed by conditional logistic regression.
Significant risk factors for rGERD were age of less than 6 years (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.7-7.5), preoperative hiatal hernia (OR, 3.2; 95% CI, 1.4-7.3), postoperative retching (OR, 5.1; 95% CI, 2.6-10.0), and postoperative esophageal dilatation (OR, 10.8; 95% CI, 1.8-65.4). Interestingly, significant association was not found between neurologic impairment and rGERD after controlling for potential confounding variables.
Age of less than 6 years, preoperative hiatal hernia, postoperative retching, and postoperative esophageal dilatation are independently associated with increased risk of rGERD. Neurologic impairment alone does not increase the risk of developing rGERD.
背景/目的：复发性胃食管反流病（rGERD）是胃底折叠术后常见的问题。以往试图确定rGERD危险因素的研究未能控制混杂变量。本研究的目的是在控制潜在混杂变量后确定rGERD的显著危险因素。
在一家三级儿童医院进行了一项回顾性配对病例对照研究。病例（n = 116）符合以下标准之一：因rGERD再次手术、有症状的rGERD（经上消化道造影、食管胃十二指肠镜检查或pH监测证实）或术后再次使用抗反流药物超过8周。对照组（n = 209）在外科医生、手术方式（腹腔镜/开放）、技术（部分/完全）和大致手术日期方面进行匹配。通过条件逻辑回归分析单变量和多变量关联。
rGERD的显著危险因素为年龄小于6岁（比值比[OR]，3.6；95%置信区间[CI]，1.7 - 7.5）、术前食管裂孔疝（OR，3.2；95%CI，1.4 - 7.3）、术后干呕（OR，5.1；95%CI，2.6 - 10.0）和术后食管扩张（OR，10.8；95%CI，1.8 - 65.4）。有趣的是，在控制潜在混杂变量后，未发现神经功能障碍与rGERD之间存在显著关联。
年龄小于6岁、术前食管裂孔疝、术后干呕和术后食管扩张与rGERD风险增加独立相关。单纯神经功能障碍不会增加发生rGERD的风险。
