Department of Surgery, Creighton University Medical Center, Omaha, NE 68131, USA.
Surg Endosc. 2011 Mar;25(3):923-9. doi: 10.1007/s00464-010-1302-9. Epub 2010 Aug 25.
Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery.
All patients who underwent antireflux surgery were entered into a prospectively maintained database. After obtaining institutional review board approval, the database was queried to identify patients who underwent primary antireflux surgery and were at least 1 year from surgery. Postoperative severity of dysphagia was evaluated using a standardized questionnaire (scale 0-3). Patients with scores of 2 or 3 were defined as having significant dysphagia.
A total of 316 consecutive patients underwent primary antireflux surgery by a single surgeon. Of these, 219 patients had 1 year postoperative symptom data. Significant postoperative dysphagia at 1 year was reported by 19 (9.1%) patients. Thirty-eight patients (18.3%) required postoperative dilation for dysphagia. Multivariate logistic regression analysis identified preoperative dysphagia (odds ratio (OR), 4.4; 95% confidence interval (CI), 1.2-15.5; p = 0.023) and preoperative delayed esophageal transit by barium swallow (OR, 8.2; 95% CI, 1.6-42.2; p = 0.012) as risk factors for postoperative dysphagia. Female gender was a risk factor for requiring dilation during the early postoperative period (OR, 3.6; 95% CI, 1.3-10.2; p = 0.016). No correlations were found with preoperative manometry. There also was no correlation between a need for early dilation and persistent dysphagia at 1 year of follow-up (p = 0.109).
Patients with preoperative dysphagia and delayed esophageal transit on preoperative contrast study were significantly more likely to report moderate to severe postoperative dysphagia 1 year after antireflux surgery. This study confirms that the manometric criteria used to define esophageal dysmotility are not reliable to identify patients at risk for postfundoplication dysphagia, and that there is need for standardization of contrast swallow assessment of esophageal function.
抗反流手术后短暂性术后吞咽困难并不少见，通常呈自限性病程。然而，有一部分患者报告存在长期吞咽困难。本研究旨在确定手术后 1 年持续性术后吞咽困难的危险因素。
所有接受抗反流手术的患者均被纳入前瞻性维护的数据库。在获得机构审查委员会批准后，对数据库进行查询，以确定接受原发性抗反流手术且距手术至少 1 年的患者。使用标准化问卷（0-3 分）评估术后吞咽困难的严重程度。评分 2 或 3 的患者被定义为存在明显吞咽困难。
共有 316 例连续患者由一名外科医生行原发性抗反流手术。其中，219 例患者术后 1 年有症状数据。19 例（9.1%）患者报告术后 1 年存在明显吞咽困难。38 例（18.3%）患者因吞咽困难需要术后扩张。多变量逻辑回归分析确定术前吞咽困难（优势比（OR），4.4；95%置信区间（CI），1.2-15.5；p=0.023）和钡餐透视显示术前食管通过延迟（OR，8.2；95%CI，1.6-42.2；p=0.012）是术后吞咽困难的危险因素。女性是术后早期需要扩张的危险因素（OR，3.6；95%CI，1.3-10.2；p=0.016）。术前测压与两者均无相关性。早期扩张与术后 1 年持续性吞咽困难之间也无相关性（p=0.109）。
术前有吞咽困难和术前对比研究显示食管通过延迟的患者，在抗反流手术后 1 年时更有可能报告中度至重度术后吞咽困难。本研究证实，用于定义食管动力障碍的测压标准不能可靠地识别术后胃底折叠术吞咽困难的风险患者，需要对食管功能的对比吞咽评估进行标准化。
