Division of Pulmonary Medicine, Department of Pediatrics, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
Pediatr Pulmonol. 2013 Jun;48(6):556-62. doi: 10.1002/ppul.22630. Epub 2012 Sep 4.
Patients with cystic fibrosis (CF) are at high risk for gastroesophageal reflux disease (GERD) and medical management of GERD improves pulmonary symptoms. Some patients with worsening CF and GERD symptoms undergo Nissen fundoplication, but the extent to which surgical management of GERD improves respiratory symptoms is not well studied. The purpose of this retrospective study was to evaluate the safety and efficacy of Nissen fundoplication in 48 patients with CF and uncontrolled GERD.
Patients exhibited significantly fewer pulmonary exacerbations, increased weight gain and slower decline in % predicted FEV1 at 2 years after the surgery, compared to 2 years before surgery. Mean change in % predicted FEV1 in 2 years before surgery was--13.57% and mean change in % predicted FEV1 in 2 years after the surgery was +1.5% and difference was significant P = 0.001. Better pulmonary and nutritional outcomes were noted among patients with milder lung disease compared to those with severe lung disease, and among patients who received gastrostomy tube feedings for ≥6 months compared to those with no G-tube or tube feedings for <6 months. There was no mortality associated with surgery.
In CF patients with worsening lung disease and uncontrolled GERD, Nissen fundoplication not only slows the decline in lung function but leads to significant improvement in weight, and decrease in CF exacerbations. Patients with milder disease and patients receiving G-tube feedings for ≥6 months after surgery benefited the most.
囊性纤维化（CF）患者患胃食管反流病（GERD）的风险很高，GERD 的医学治疗可改善肺部症状。一些 CF 恶化和 GERD 症状的患者接受了 Nissen 胃底折叠术，但 GERD 的手术治疗改善呼吸症状的程度尚未得到很好的研究。本回顾性研究的目的是评估 Nissen 胃底折叠术在 48 例 CF 和 GERD 未得到控制的患者中的安全性和疗效。
与手术前 2 年相比，患者在手术后 2 年内肺部恶化发作明显减少，体重增加，预计 FEV1%的下降速度减慢。手术前 2 年预计 FEV1%的平均变化为-13.57%，手术后 2 年预计 FEV1%的平均变化为+1.5%，差异具有统计学意义（P=0.001）。与严重肺部疾病的患者相比，轻度肺部疾病的患者以及接受胃造口管喂养≥6 个月的患者比没有胃造口管或管饲喂养<6 个月的患者具有更好的肺部和营养预后。手术无相关死亡。
在肺部疾病恶化且 GERD 未得到控制的 CF 患者中，Nissen 胃底折叠术不仅减缓了肺功能的下降速度，而且还导致了体重的显著增加和 CF 恶化的减少。疾病较轻的患者和手术后接受胃造口管喂养≥6 个月的患者受益最大。
