Rijnhart-De Jong Hilda G, Draaisma Werner A, Smout André J P M, Broeders Ivo A M J, Gooszen Hein G
Department of Surgery, University Medical Center Utrecht, The Netherlands.
Scand J Gastroenterol. 2008;43(7):787-93. doi: 10.1080/00365520801935467.
In scoring the outcome of antireflux surgery, it is extremely difficult to combine the effect on reflux symptoms and esophageal acid exposure in one and the same single system - the Visick score revisited. The aim of this study was to correlate subjective outcome variables and objective outcome variables in an attempt to come to an overall reproducible scoring system.
From 1997 to 1999, a randomized trial was set up to compare 98 patients who had undergone laparoscopic Nissen fundoplication (LNF) with 79 patients treated with conventional Nissen fundoplication (CNF). All patients were requested to complete a questionnaire, before and 3, 6, 12, 24 and 60 months after surgery. A subgroup of 87 patients agreed to undergo objective evaluation by pH-metry. The results of all these assessments were correlated with the effect of surgery on the Visick score.
After LNF and CNF, 79 and 69 patients, respectively, completed the questionnaires. After 5 years, complaints about heartburn, regurgitation and dysphagia were still significantly improved in the majority of patients, but in these groups, 6, 3 and 27% of patients, respectively, experienced deterioration. Visick score I or II (complaints resolved or improved) was recorded by 87% of patients. The Visick score correlated with the reduction of postoperative reflux symptom grades for heartburn, but not with the reduction of regurgitation, dysphagia and esophageal acid exposure.
Although this study shows that the Visick score can be applied to monitor the subjective effect of primary antireflux surgery as it correlates well with the most prominent symptom of GERD (heartburn), it also underlines the difficulty in adequately scoring symptomatic outcome of antireflux surgery.
在对抗反流手术的结果进行评分时，要在同一个单一系统中综合考量对反流症状和食管酸暴露的影响极为困难——重新审视维西克评分。本研究的目的是将主观结果变量和客观结果变量进行关联，以尝试得出一个整体可重复的评分系统。
1997年至1999年，开展了一项随机试验，比较98例行腹腔镜尼氏胃底折叠术（LNF）的患者与79例行传统尼氏胃底折叠术（CNF）的患者。所有患者在手术前以及术后3、6、12、24和60个月均被要求完成一份问卷。87例患者的亚组同意接受pH值测定的客观评估。所有这些评估的结果与手术对维西克评分的影响相关联。
LNF和CNF术后，分别有79例和69例患者完成了问卷。5年后，大多数患者关于烧心、反流和吞咽困难的主诉仍有显著改善，但在这些组中，分别有6%、3%和27%的患者病情恶化。87%的患者记录为维西克评分I或II（主诉缓解或改善）。维西克评分与术后烧心反流症状等级的降低相关，但与反流、吞咽困难和食管酸暴露的降低无关。
尽管本研究表明维西克评分可用于监测初次抗反流手术的主观效果，因为它与GERD最突出的症状（烧心）相关性良好，但它也凸显了对抗反流手术症状性结果进行充分评分的困难。
