Hafez J, Wrba F, Lenglinger J, Miholic J
Department of Surgery, Medical University Vienna, Vienna, Austria.
Surg Endosc. 2008 Aug;22(8):1763-8. doi: 10.1007/s00464-008-9872-5. Epub 2008 May 1.
The impact from the mode of operation (partial vs total fundoplication) on long-term outcome after fundoplication still is unknown, although short-term randomized studies have not shown significant differences in the efficacy of reflux control. To obtain some insight concerning the long-term results, the data of a nonrandomized cohort were analyzed using propensity score statistics.
For 134 patients who underwent laparoscopic fundoplication for gastroesophageal reflux disease (GERD), the time until recurrence of reflux symptoms was assessed. The impact of putative prognostic factors and the mode of operation (partial vs total fundoplication) on outcome were tested for significance using univariate and multivariate statistics, including the propensity score, correcting for nonrandomized treatment groups. The follow-up period was 60 to 123 months (median, 93 months). In this study, 45 patients had a partial (Toupet) fundoplication, and 89 patients underwent a total (Nissen) fundoplication.
The rate of recurrence after 93 months (the median follow-up interval) was 14% after Nissen and 9% after Toupet fundoplication (nonsignificant difference) as estimated according to Kaplan and Meier. Massive acid exposure to the esophagus was associated with an increased risk of recurrence for 23% of the patients with a DeMeester score of 50 or higher, but only for 9% of the patients with less severe reflux (DeMeester score <50; p < 0.05). Multiple proportional hazard regression using the propensity score did not show additional significance for the variables of age, gender, presence of a Barrett esophagus, and mode of operation.
The operation method did not have a significant impact on the efficacy of laparoscopic fundoplication in a cohort during a follow-up period of 60 to 123 months (median, 93 months).
尽管短期随机研究未显示反流控制疗效存在显著差异，但贲门折叠术的手术方式（部分与完全贲门折叠术）对贲门折叠术后长期疗效的影响仍不明确。为深入了解长期结果，使用倾向评分统计分析了一个非随机队列的数据。
对134例因胃食管反流病（GERD）接受腹腔镜贲门折叠术的患者，评估反流症状复发的时间。使用单变量和多变量统计方法（包括倾向评分）检验假定的预后因素和手术方式（部分与完全贲门折叠术）对结果的影响，以校正非随机治疗组。随访期为60至123个月（中位数为93个月）。本研究中，45例患者接受了部分（Toupet）贲门折叠术，89例患者接受了完全（Nissen）贲门折叠术。
根据Kaplan-Meier估计，93个月（中位随访间隔）后，Nissen术后复发率为14%，Toupet贲门折叠术后为9%（无显著差异）。食管大量酸暴露与DeMeester评分≥50的患者中23%的复发风险增加相关，但在反流较轻（DeMeester评分<50）的患者中仅为9%（p<0.05）。使用倾向评分的多比例风险回归未显示年龄、性别、Barrett食管的存在和手术方式等变量有额外的显著意义。
在60至123个月（中位数为93个月）的随访期内，手术方式对腹腔镜贲门折叠术队列的疗效没有显著影响。
