Department of Surgery and Cancer, Imperial College London, London.
J Heart Lung Transplant. 2013 Jun;32(6):588-95. doi: 10.1016/j.healun.2013.02.009. Epub 2013 Mar 27.
The aim of this study was to determine the safety of anti-reflux surgery for lung transplant recipients and assess its effect on lung function.
We retrospectively collected and analyzed data from all lung transplant recipients who underwent anti-reflux surgery at St Mary's Hospital London from July 2005 to May 2012. The indications for surgery were histologic evidence of gastroesophageal reflux aspiration on bronchoscopy biopsy specimens or a positive impedance study with symptomatic reflux or a consistent decline/fluctuating forced expiratory volume in 1 second (FEV(1)). We studied the difference in mean FEV(1) and rate of change of FEV(1), before and after fundoplication. The safety of anti-reflux surgery was determined by post-operative morbidity and mortality and compared with predicted figures, using a risk prediction model based on the P-POSSUM (Portsmouth Modification of the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) assessment.
Forty patients underwent laparoscopic Nissen fundoplication. Overall, mean FEV(1) declined from 2119 ± 890 to 1967 ± 1027 ml (p = 0.027), and mean rate of change in FEV(1) improved from -2.42 ± 4.40 to -0.41 ± 1.77 ml/day (p = 0.007). Patients referred for fundoplication based on histologic evidence of reflux (n = 9) showed an improvement in rate of change of FEV(1) from -3.39 ± 6.00 to -0.17 ± 1.50 ml/day (p = 0.057), and those with positive impedance study and consistent decline in FEV(1) (n = 13) showed a significant improvement from -3.62 ± 3.35 to -0.74 ± 2.33 ml (p = 0.021). Actual and predicted morbidity was 2.5% and 31%, respectively. Actual and predicted 30-day mortality was 0% and 1.9%, respectively.
Anti-reflux surgery is safe for lung transplant recipients and results in an improvement in the rate of change in FEV(1) despite a decline in mean FEV(1) post-operatively.
本研究旨在确定抗反流手术治疗肺移植受者的安全性，并评估其对肺功能的影响。
我们回顾性收集了 2005 年 7 月至 2012 年 5 月在伦敦圣玛丽医院接受抗反流手术的所有肺移植受者的数据。手术指征为支气管镜活检标本中有胃食管反流吸入的组织学证据，或阻抗研究阳性伴有症状性反流或持续下降/波动的 1 秒用力呼气量（FEV1）。我们研究了在进行胃底折叠术前后 FEV1 的平均变化率和变化率的差异。通过术后发病率和死亡率来确定抗反流手术的安全性，并使用基于 P-POSSUM（朴茨茅斯生理和手术严重程度评分用于死亡率和发病率的修改）评估的风险预测模型与预测数据进行比较。
40 例患者接受了腹腔镜 Nissen 胃底折叠术。总体而言，FEV1 从 2119±890ml 下降至 1967±1027ml（p=0.027），FEV1 的平均变化率从-2.42±4.40ml/天改善至-0.41±1.77ml/天（p=0.007）。根据反流的组织学证据转诊行胃底折叠术的患者（n=9），FEV1 的变化率从-3.39±6.00ml/天改善至-0.17±1.50ml/天（p=0.057），而那些有阳性阻抗研究和持续下降的 FEV1（n=13）的患者从-3.62±3.35ml 显著改善至-0.74±2.33ml（p=0.021）。实际和预测的发病率分别为 2.5%和 31%。实际和预测的 30 天死亡率分别为 0%和 1.9%。
抗反流手术对肺移植受者是安全的，尽管术后 FEV1 平均水平下降，但 FEV1 的变化率有所改善。
