Kent Michael S, Luketich James D, Irshad Kashif, Awais Omar, Alvelo-Rivera Miguel, Churilla Patricia, Fernando Hiran C, Landreneau Rodney J
Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232, USA.
Ann Thorac Surg. 2007 Nov;84(5):1710-5; discussion 1715-6. doi: 10.1016/j.athoracsur.2007.06.025.
Scleroderma is associated with severe esophageal dysmotility and gastroesophageal reflux disease (GERD). Results after antireflux surgery have been suboptimal due to the profound esophageal dysmotility seen in this disease. We hypothesized that laparoscopic Roux-en-Y gastric bypass (RYGBP) would lead to less dysphagia and better control of GERD symptoms. This report summarizes our initial results of RYGBP compared with other surgical approaches.
A retrospective review identified scleroderma patients who underwent surgical management of GERD from 1995 to 2006. Complications and reinterventions were recorded. Symptom control was assessed by validated questionnaires that measured dysphagia (0 to 5; 0 = no dysphagia), GERD-heartburn-related quality of life index (0 to 45; 0 = best, 45 = worst), and overall quality of life with the Medical Outcomes Study 36-Item Short Form Health Survey.
Twenty-three scleroderma patients underwent surgical treatment for GERD (fundoplication, n = 10; RYGBP, n = 8; esophagectomy, n = 5). One patient died after esophagectomy and major morbidity occurred in 3 of the remaining 4 patients. No major complications occurred in any patient undergoing either fundoplication or RYGBP. Eighteen patients underwent evaluation by questionnaire at a median of 21 months postoperatively. Decreased dysphagia (0.42 versus 1.86, p = 0.05) and improved control of reflux (GERD-heartburn-related quality of life index score 4 versus 15.6, p = 0.05) were observed in the RYGBP patients compared with those undergoing fundoplication.
A high complication rate was seen among patients undergoing esophagectomy. Both reflux control and dysphagia rates were improved in the RYGBP group compared with fundoplication. This finding suggests that RYGBP may be an option for the primary management of scleroderma-associated gastroesophageal reflux.
硬皮病与严重的食管动力障碍和胃食管反流病（GERD）相关。由于该病存在严重的食管动力障碍，抗反流手术后的效果并不理想。我们推测腹腔镜Roux-en-Y胃旁路术（RYGBP）会减少吞咽困难并更好地控制GERD症状。本报告总结了RYGBP与其他手术方法相比的初步结果。
一项回顾性研究确定了1995年至2006年接受GERD手术治疗的硬皮病患者。记录并发症和再次干预情况。通过经过验证的问卷评估症状控制情况，这些问卷测量吞咽困难（0至5分；0 = 无吞咽困难）、GERD-烧心相关生活质量指数（0至45分；0 = 最佳，45 = 最差）以及使用医学结果研究36项简式健康调查评估总体生活质量。
23例硬皮病患者接受了GERD手术治疗（胃底折叠术，n = 10；RYGBP，n = 8；食管切除术，n = 5）。1例患者在食管切除术后死亡，其余4例患者中有3例发生严重并发症。接受胃底折叠术或RYGBP的患者均未发生重大并发症。18例患者在术后中位时间21个月接受问卷调查评估。与接受胃底折叠术的患者相比，RYGBP患者的吞咽困难有所减轻（0.42对1.86，p = 0.05），反流控制得到改善（GERD-烧心相关生活质量指数评分4对15.6，p = 0.05）。
食管切除术患者的并发症发生率较高。与胃底折叠术相比，RYGBP组的反流控制和吞咽困难发生率均有所改善。这一发现表明RYGBP可能是硬皮病相关胃食管反流的主要治疗选择。
