先天性膈疝患者严重胃食管反流的累积发病率——一项系统的临床、pH值测定及内镜随访研究

The cumulative incidence of significant gastroesophageal reflux in patients with congenital diaphragmatic hernia-a systematic clinical, pH-metric, and endoscopic follow-up study.

作者信息

Koivusalo Antti I, Pakarinen Mikko P, Lindahl Harry G, Rintala Risto J

机构信息

Hospital for Children and Adolescents, University of Helsinki, PO Box 281, LNS, HUS, 00029 Helsinki, Finland.

出版信息

J Pediatr Surg. 2008 Feb;43(2):279-82. doi: 10.1016/j.jpedsurg.2007.10.014.

DOI:10.1016/j.jpedsurg.2007.10.014

PMID:18280274

Abstract

BACKGROUND

Gastroesophageal reflux (GER) is common in patients with congenital diaphragmatic hernia (CDH). Gastroesophageal reflux may occur early after the primary repair of CDH and require antireflux surgery (ARS). It is unknown how many patients will be severely affected later on. We conducted an objective long-term follow-up for the cumulative incidence of CDH-associated GER based on symptoms, pH-metry, and histology.

MATERIALS AND METHODS

From March 1990 to July 2006, we admitted 33 newborn patients with CDH. Twenty-six patients (79%) (male 13, left-sided 21) survived. Extracorporeal membrane oxygenation was required in one patient and patch closure in 10 patients. The follow-up consisted of assessment of GER symptoms at 6 months, 1 year, 3 years, 5 years, and 10 years; endoscopy; and pH-metry for all patients at 1 year and to selected patients (with symptoms or complications of GER) from 3 to 10 years after the primary closure of CDH. Gastroesophageal reflux was considered significant (sGER) when a symptomatic patient required ARS, had endoscopic biopsies showing at least moderate esophagitis, or total and preprandial reflux index of more than 10% and 5%, respectively.

MAIN RESULTS

The incidence of sGER (patients with sGER/total amount assessed) at 6 months, 1 year, 3 years, 5 years, and 10 years was 27% (7/26), 42% (11/26), 53% (8/15), 53% (8/15), and 55% (5/9), respectively. During a median follow-up of 60 months (range, 12-195 months), 12 (46%) of 26 patients had sGER and 4 (15%) required ARS. After the assessment at 1 year, only one new case of sGER appeared. Endoscopic and/or pH-metric assessment covered 100% of the patients at 1 year follow-up, but later on only 70%.

CONCLUSION

One year after the primary closure of CDH, the incidence of sGER was 42%. After 1 year follow-up, only one new case of sGER was found, and ARS was not required. In patients who required ARS manifested before 6 months.

摘要

背景

胃食管反流（GER）在先天性膈疝（CDH）患者中很常见。胃食管反流可能在CDH初次修复后早期发生，并需要抗反流手术（ARS）。目前尚不清楚有多少患者随后会受到严重影响。我们基于症状、pH值监测和组织学对CDH相关GER的累积发病率进行了客观的长期随访。

材料与方法

1990年3月至2006年7月，我们收治了33例CDH新生儿患者。26例（79%）（男性13例，左侧21例）存活。1例患者需要体外膜肺氧合，10例患者需要补片修补。随访包括在6个月、1年、3年、5年和10年时评估GER症状；对所有患者在1年时进行内镜检查和pH值监测，对CDH初次修补术后3至10年有GER症状或并发症的部分患者进行内镜检查和pH值监测。当有症状的患者需要ARS、内镜活检显示至少中度食管炎、或总反流指数和餐前反流指数分别超过10%和5%时，胃食管反流被认为是显著的（sGER）。

主要结果

6个月、1年、3年、5年和10年时sGER的发病率（sGER患者数/评估总数）分别为27%（7/26）、42%（11/26）、53%（8/15）、53%（8/15）和55%（5/9）。在中位随访60个月（范围12 - 195个月）期间，26例患者中有12例（46%）有sGER，4例（15%）需要ARS。在1年评估后，仅出现1例新的sGER病例。1年随访时内镜和/或pH值监测覆盖了100%的患者，但之后仅覆盖70%。