Gasper Warren J, Sweet Matthew P, Golden Jeffrey A, Hoopes Charles, Leard Lorriana E, Kleinhenz Mary Ellen, Hays Steven R, Patti Marco G
Department of Surgery, University of California, San Francisco, CA 94143-0790, USA.
Dis Esophagus. 2008;21(7):650-5. doi: 10.1111/j.1442-2050.2008.00828.x. Epub 2008 May 2.
Lung and esophageal dysfunction are common in patients with connective tissue disease (CTD). Recent reports have suggested a link between pathologic gastroesophageal reflux and bronchiolitis obliterans syndrome (BOS) after lung transplant. Because patients with CTD have a high incidence of esophageal dysmotility and reflux, this group may be at increased risk of allograft dysfunction after lung transplantation. Little is known about antireflux surgery in these patients. Our aims were to describe: (i) the esophageal motility and reflux profile of patients with CTD referred for lung transplantation; and (ii) the safety and outcomes of laparoscopic fundoplication in this group. A retrospective review of 26 patients with CTD referred for lung transplantation between July 2003 and June 2007 at a single center. Esophageal studies included manometry and ambulatory 24-h pH monitoring. Twenty-three patients had esophageal manometry and ambulatory 24-h pH monitoring. Nineteen patients (83%) had pathologic distal reflux and 7 (30%) also had pathologic proximal reflux. Eighteen patients (78%) had impaired or absent peristalsis. Eleven of 26 patients underwent lung transplantation. Ten patients are alive at a median follow-up of 26 months (range 3-45) and one has bronchiolitis obliterans syndrome-1. Six patients had a laparoscopic fundoplication, 1 before transplantation and 5 after. All fundoplication patients are alive at median follow-up of 25 months (range 19-45). In conclusion, esophageal dysmotility and reflux are common in CTD patients referred for lung transplant. For this group, laparoscopic fundoplication is safe in experienced hands.
肺部和食管功能障碍在结缔组织病（CTD）患者中很常见。最近的报告表明，病理性胃食管反流与肺移植后闭塞性细支气管炎综合征（BOS）之间存在联系。由于CTD患者食管动力障碍和反流的发生率很高，这组患者在肺移植后发生移植物功能障碍的风险可能增加。对于这些患者的抗反流手术知之甚少。我们的目的是描述：（i）因肺移植而转诊的CTD患者的食管动力和反流情况；（ii）该组患者行腹腔镜胃底折叠术的安全性和结果。对2003年7月至2007年6月在单一中心因肺移植而转诊的26例CTD患者进行回顾性研究。食管检查包括测压和24小时动态pH监测。23例患者进行了食管测压和24小时动态pH监测。19例患者（83%）存在病理性远端反流，7例（30%）也存在病理性近端反流。18例患者（78%）蠕动减弱或消失。26例患者中有11例接受了肺移植。10例患者存活，中位随访26个月（范围3 - 45个月），1例患有闭塞性细支气管炎综合征1级。6例患者接受了腹腔镜胃底折叠术，1例在移植前，5例在移植后。所有接受胃底折叠术的患者在中位随访25个月（范围19 - 45个月）时均存活。总之，因肺移植而转诊的CTD患者中食管动力障碍和反流很常见。对于这组患者，在经验丰富的医生操作下，腹腔镜胃底折叠术是安全的。
