Kala Z, Weber P, Prochazka V, Dolina J, Kysela P, Marek F
Department of Surgery, Faculty of Medicine Masaryk University and Faculty Hospital Brno, Brno, Czech Republic.
J Nutr Health Aging. 2008 Nov;12(9):678-80. doi: 10.1007/BF03008282.
With increasing age, the functional condition of the lower esophageal sphincter is getting weaker. Recent progress in peri-operative intensive care and the development of laparoscopic technique makes antireflux surgery a safe choice of GERD treatment in the elderly.
This work evaluated the long-term results of tailored antireflux surgery in a group of elderly (more than 60 years old) patients.
Five hundred and eighty one patients underwent antireflux surgery in our department from 1999 to 2005. Seventy of them (12.0%) were older than 60 years. Exclusion criteria of surgery were ASA IV classification and high grade esophageal dysmotility. Toupet's wrap was offered to patients with esophageal dysmotility or esophageal sphincter pressure higher than 15 mm Hg (16 cases). The rest were offered Nissen-Rossetti's complete wrap (54 cases). There was zero mortality and no further significant dysphagia. Pathological gastro-esophageal reflux after the surgery was detected in 6 patients (8.6%), which was a higher proportion than in the group of patients under 60 years.
Good results of antireflux surgery with zero mortality and low morbidity can be achieved even in the elderly (more frequent use of incomplete Toupet's wrap).
随着年龄增长，食管下括约肌的功能状态逐渐减弱。围手术期重症监护的最新进展以及腹腔镜技术的发展，使抗反流手术成为老年GERD患者治疗的安全选择。
本研究评估了一组老年（60岁以上）患者行个体化抗反流手术的长期效果。
1999年至2005年，我科共有581例患者接受了抗反流手术。其中70例（12.0%）年龄超过60岁。手术排除标准为ASA IV级分类和高度食管动力障碍。对于有食管动力障碍或食管括约肌压力高于15 mmHg的患者采用Toupet包绕术（16例）。其余患者采用Nissen-Rossetti全胃包绕术（54例）。死亡率为零，无进一步明显吞咽困难。术后6例（8.6%）检测到病理性胃食管反流，这一比例高于60岁以下患者组。
即使在老年患者中（更频繁地使用不完全Toupet包绕术），抗反流手术也能取得死亡率为零、发病率低的良好效果。
