Ross Sharona B, Villadolid Desiree, Paul Harold, Al-Saadi Sam, Gonzalez Javier, Cowgill Sarah M, Rosemurgy Alexander
Digestive Disorders Center, Tampa General Hospital, Florida 33601, USA.
Am Surg. 2008 Jul;74(7):635-42; discussion 643.
Intuitively, more severe acid reflux causes more severe symptoms. This study was undertaken to correlate preoperative DeMeester scores with symptoms before and after laparoscopic Nissen fundoplication. Before fundoplication, all patients with gastroesophageal reflux disease underwent 24 to 48 hour pH testing. Before and after fundoplication, the frequency and severity of reflux symptoms were scored using a Likert scale. Four hundred and eighty-one patients underwent fundoplication and were followed for a mean of 32 months. The preoperative median DeMeester score was 41 (range 14.8 to 361.5). Before fundoplication, DeMeester scores correlated with severity of gastroesophageal reflux disease symptoms (Spearman regression analysis, P < 0.05 for all). Postoperatively, all symptom scores improved (Wilcoxon matched pairs test, P < 0.05 for all). After fundoplication, preoperative DeMeester scores did not correlate with the frequency or severity of symptoms. For patients with excessive acid reflux, reflux severity impacts the frequency and severity of symptoms before fundoplication. Laparoscopic Nissen fundoplication improves the frequency and severity of all reflux symptoms. The severity of preoperative reflux does not impact the frequency or severity of symptoms after fundoplication. Relief of excessive acid reflux, regardless of severity or degree (i.e., DeMeester scores), ameliorates symptoms of acid reflux thereby encouraging fundoplication, especially for patients with very abnormal DeMeester scores.
直观地说，更严重的胃酸反流会导致更严重的症状。本研究旨在将术前的DeMeester评分与腹腔镜Nissen胃底折叠术前后的症状进行关联。在进行胃底折叠术之前，所有胃食管反流病患者都接受了24至48小时的pH值测试。在胃底折叠术前后，使用李克特量表对反流症状的频率和严重程度进行评分。481例患者接受了胃底折叠术，并进行了平均32个月的随访。术前DeMeester评分的中位数为41（范围为14.8至361.5）。在胃底折叠术之前，DeMeester评分与胃食管反流病症状的严重程度相关（Spearman回归分析，所有P<0.05）。术后，所有症状评分均有所改善（Wilcoxon配对检验，所有P<0.05）。胃底折叠术后，术前DeMeester评分与症状的频率或严重程度无关。对于胃酸反流过多的患者，反流严重程度会影响胃底折叠术之前症状的频率和严重程度。腹腔镜Nissen胃底折叠术可改善所有反流症状的频率和严重程度。术前反流的严重程度不会影响胃底折叠术后症状 的频率或严重程度。消除过多的胃酸反流，无论其严重程度或程度如何（即DeMeester评分），均可改善胃酸反流症状，从而鼓励进行胃底折叠术，尤其是对于DeMeester评分非常异常的患者。
