Hazebroek E J, Gananadha S, Koak Y, Berry H, Leibman S, Smith G S
Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
Dis Esophagus. 2008;21(8):737-41. doi: 10.1111/j.1442-2050.2008.00831.x. Epub 2008 May 2.
Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70-85); mean American Society of Anesthesiologists class was 2.7 (range 1-3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2-14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion.
食管旁疝（PEH）是指胃通过扩张的食管裂孔发生疝出。这些疝在老年人中更为常见，尽管药物治疗无法解决机械性症状和危及生命的并发症，但老年人往往未接受手术治疗。本研究的目的是评估腹腔镜修复PEH对老年人群生活质量的影响。前瞻性收集了2001年12月至2005年9月期间连续35例年龄>70岁、因有症状的PEH接受腹腔镜修复的患者的数据。使用经过验证的问卷——反流和消化不良生活质量问卷（QOLRAD）以及患者访谈来评估生活质量的变化。对患者进行术前评估以及术后6周、6个月、12个月、1年和2年的评估。患者平均年龄为77岁（范围70 - 85岁）；美国麻醉医师协会平均分级为2.7（范围1 - 3）。有28名女性和7名男性。有1例因急性复发疝再次入院，需要进行开放修复。总并发症发生率为17.1%。所有并发症经治疗后均无残留残疾。无30天死亡率，中位住院时间为3天（范围2 - 14天）。3所5例患者中有30例（85.7%）完成了问卷。在所有术后时间点，用QOLRAD测量的生活质量均有显著改善（P < 0.001）。对于保守治疗无效的有症状患者，腹腔镜PEH修复术的发病率可接受，并与生活质量的显著改善相关。我们的数据支持对有症状的老年PEH患者进行择期修复，这一人群可能并不总是会被转诊以获得手术意见。
