Ihde Surgical Group, PA, Arlington, TX 76014, USA.
Am J Surg. 2011 Dec;202(6):740-6; discussion 746-7. doi: 10.1016/j.amjsurg.2011.06.035. Epub 2011 Oct 20.
A retrospective community-based study evaluated the safety and symptomatic outcomes of the transoral incisionless fundoplication (TIF) procedure with or without hiatal hernia repair (HHR) in patients with chronic gastroesophageal reflux disease (GERD).
Forty-eight patients underwent TIF using EsophyX (EndoGastric Solutions, Redmond, WA) in 3 community hospitals. Patients who presented with a hiatal hernia 3 cm or more in the greatest transverse diameter underwent laparoscopic HHR before TIF.
Forty-two patients completed follow-up assessment at a median of 6 (range 1-11) months. Laparoscopic HHR was performed in 18 (43%) patients before TIF. There were no long-term postoperative complications. GERD-health related quality of life scores indicated heartburn elimination in 63% of patients. The need for daily proton pump inhibitor (PPI) therapy was eliminated in 76% of patients. Atypical symptom relief measured by the median reflux symptom index score reduction was significant (5 [0-47] vs 22 [2-42] on PPIs, P < .001).
Our results support the safety and symptomatic improvement of TIF with or without laparoscopic HHR. The patients' symptoms were significantly improved, and PPI use was significantly reduced.
一项回顾性社区研究评估了经口无切口胃底折叠术（TIF）联合或不联合食管裂孔疝修补术（HHR）治疗慢性胃食管反流病（GERD）患者的安全性和症状改善结果。
在 3 家社区医院，48 例患者接受了 EsophyX（EndoGastric Solutions，Redmond，WA）行 TIF。最大横径为 3cm 或以上的食管裂孔疝患者在 TIF 前行腹腔镜 HHR。
42 例患者在中位时间 6 个月（范围 1-11 个月）时完成了随访评估。在 TIF 前，18 例（43%）患者行腹腔镜 HHR。无长期术后并发症。GERD 健康相关生活质量评分表明，63%的患者烧心症状消除。76%的患者不再需要每日质子泵抑制剂（PPI）治疗。通过反流症状指数评分中位数的降低来衡量，非典型症状缓解显著（PPI 时为 5 [0-47]，无 PPI 时为 22 [2-42]，P<0.001）。
我们的结果支持 TIF 联合或不联合腹腔镜 HHR 的安全性和症状改善。患者症状显著改善，PPI 使用明显减少。
