Department of General Surgery, Vernon Jubilee Hospital, Vernon, and the Faculty of Medicine, University of British Columbia, Vancouver, BC.
Can J Surg. 2012 Feb;55(1):41-5. doi: 10.1503/cjs.018210.
Gastroesophageal reflux disease (GERD) is a prevalent condition leading to poor quality of life (QOL) in patients with refractory symptoms. Laparoscopic antireflux (LAR) surgery has been shown to improve QOL, and I sought to examine the surgical and QOL outcomes associated with LAR surgery over a 3-year period at a regional hospital.
Patients were given GERD-health related quality of life (GERD-HRQL) and SF-36 questionnaires preoperatively, at 6 months and at 12 or more months after surgery. I collected data on demographic and clinical characteristics and surgical outcomes.
Of the 342 patients referred for GERD or dysphagia, 26 received LAR surgery during the study period. All 26 patients had symptoms refractory to medications; 19 had atypical symptoms and 8 had some form of chronic pain syndrome (CPS). The mean duration of surgery was 125 minutes. There were no conversions, complications, 30-day readmissions or deaths. Three patients stayed 2 days in hospital and 23 stayed overnight. One patient required esophageal dilation for persistent dysphagia. Two patients resumed medication for recurrent symptoms and 24 remained medication free. There were significant improvements in GERD-HRQL scores in all patients. Patients with CPS had no improvements in SF-36 scores, whereas patients without CPS showed significant improvement.
Excellent surgical outcomes in LAR surgery can be obtained with careful patient selection at a nonacademic regional hospital. Although GERD-HRQL improved in all patients, patients with CPS showed no improvement in general health QOL scores after LAR surgery. Careful patient counselling should be employed when offering LAR surgery to patients with CPS.
胃食管反流病（GERD）是一种普遍存在的疾病，会导致有难治性症状的患者生活质量（QOL）下降。腹腔镜抗反流（LAR）手术已被证明可以改善 QOL，我试图在一家地区医院的 3 年期间，研究 LAR 手术后的手术和 QOL 结果。
患者在术前、术后 6 个月和 12 个月或更长时间接受 GERD 健康相关生活质量（GERD-HRQL）和 SF-36 问卷。我收集了人口统计学和临床特征以及手术结果的数据。
在 342 名因 GERD 或吞咽困难而转诊的患者中，有 26 名在研究期间接受了 LAR 手术。所有 26 名患者的症状均对药物治疗无反应；19 名患者有非典型症状，8 名患者有某种形式的慢性疼痛综合征（CPS）。手术平均持续 125 分钟。无转换、并发症、30 天再入院或死亡。3 名患者在医院住了 2 天，23 名患者住了一晚。1 名患者因持续性吞咽困难需要食管扩张。2 名患者因复发症状恢复用药，24 名患者继续停药。所有患者的 GERD-HRQL 评分均显著改善。有 CPS 的患者 SF-36 评分没有改善，而没有 CPS 的患者则有显著改善。
在非学术性地区医院，通过仔细选择患者，LAR 手术可以获得良好的手术效果。尽管所有患者的 GERD-HRQL 均有所改善，但接受 LAR 手术后，有 CPS 的患者一般健康 QOL 评分没有改善。在向有 CPS 的患者提供 LAR 手术时，应谨慎进行患者咨询。
