University of South Florida and Tampa General Hospital Digestive Disorders Center, Tampa, FL, USA.
J Gastrointest Surg. 2010 Aug;14(8):1214-9. doi: 10.1007/s11605-010-1240-9. Epub 2010 Jun 15.
Laparoscopic Nissen fundoplication offers significant improvement in gastroesophageal reflux disease (GERD) symptom severity and frequency. This study was undertaken to determine the impact of preoperative medical comorbidities on the outcome and satisfaction of patients undergoing fundoplication for GERD.
Prior to fundoplication, patients underwent esophageal motility testing and 24-h pH monitoring. Before and after fundoplication, the frequency and severity of reflux symptoms were scored using a Likert scale. Medical comorbidities were classified by organ systems, and patients were assigned points corresponding to the number of medical comorbidities they had. In addition, all patients were assigned Charlson comorbidity index (CCI) scores according to the medical comorbidities they had. A medical comorbidity was defined as a preexisting medical condition, not related to GERD, for which the patient was receiving treatment. Analyses were then conducted to determine the impact of medical comorbidities as well as CCI score on overall outcome, symptom improvement, and satisfaction.
Six hundred and ninety-six patients underwent fundoplication: 538 patients had no medical comorbidities and 158 patients had one or more medical comorbidities. Preoperatively, there were no differences in symptom severity and frequency scores between patients with or without medical comorbidities. Postoperatively, all patients had improvement in their symptom severity and frequency scores. There were no differences in postoperative symptom scores between the patients with medical comorbidities and those without. The majority of patients were satisfied with their overall outcome; there was no relationship between the number of medical comorbidities and satisfaction scores. These findings were mirrored when patients' CCI scores were compared with satisfaction, overall outcome, and symptom improvement.
These results promote further application of laparoscopic Nissen fundoplication, even for patients with medical comorbidities.
腹腔镜 Nissen 胃底折叠术可显著改善胃食管反流病（GERD）的症状严重程度和频率。本研究旨在确定术前合并症对胃食管反流病患者行胃底折叠术的结果和满意度的影响。
在进行胃底折叠术前，患者接受食管动力检查和 24 小时 pH 监测。在胃底折叠术前和术后，使用 Likert 量表对反流症状的频率和严重程度进行评分。根据器官系统对合并症进行分类，并根据患者合并症的数量给他们分配相应的分数。此外，根据患者合并症的数量，为所有患者分配 Charlson 合并症指数（CCI）评分。合并症定义为与 GERD 无关但正在接受治疗的既往疾病。然后进行分析，以确定合并症以及 CCI 评分对整体结果、症状改善和满意度的影响。
696 例患者接受了胃底折叠术：538 例患者无合并症，158 例患者有 1 种或多种合并症。术前，有合并症和无合并症患者的症状严重程度和频率评分无差异。术后，所有患者的症状严重程度和频率评分均有所改善。有合并症的患者和无合并症的患者术后症状评分无差异。大多数患者对整体结果感到满意；合并症的数量与满意度评分无关。当将患者的 CCI 评分与满意度、整体结果和症状改善进行比较时，也发现了同样的结果。
这些结果促进了腹腔镜 Nissen 胃底折叠术的进一步应用，即使是对于合并症患者。
