Staehelin Annina, Zingg Urs, Devitt Peter G, Esterman Adrian J, Smith Lorelle, Jamieson Glyn G, Watson David I
Discipline of Surgery, University of Adelaide, Adelaide, SA, Australia.
World J Surg. 2014 Jun;38(6):1431-43. doi: 10.1007/s00268-013-2415-9.
Antireflux surgery is effective for the treatment of gastroesophageal reflux, but not all patients benefit equally from it. The challenge is to identify the patients who will ultimately benefit from antireflux surgery. The aim of this study was to identify preoperative factors that predict clinical outcome after antireflux surgery, with special interest in the influence of socioeconomic factors.
Preoperative clinical and socioeconomic data from 1,650 patients who were to undergo laparoscopic fundoplication were collected prospectively. Clinical outcome measures (persistent heartburn, dysphagia, satisfaction) were assessed at short-term (1 year) and longer-term (≥ 3 years) follow-up.
At early follow-up, male gender (relative risk [RR] 1.091, p < 0.001) and the presence of a hiatus hernia (RR 1.065, p = 0.002) were independently associated with less heartburn. Male gender was also associated with higher overall satisfaction (RR 1.046, p = 0.034). An association was found between postoperative dysphagia and age (RR 0.988, p = 0.007) and the absence of a hiatus hernia (RR 0.767, p = 0.001). At longer-term follow-up, only male gender (RR 1.125, p < 0.001) was an independent prognostic factor for heartburn control. Male gender (RR 0.761, p = 0.001), the presence of a hiatus hernia (RR 0.823, p = 0.014), and cerebrovascular comorbidities (RR 1.306, p = 0.019) were independent prognosticators for dysphagia at longer-term follow-up. A hiatus hernia was the only factor associated with better overall satisfaction. Socioeconomic factors did not influence any clinical outcomes at short- and longer-term follow-up.
Male gender and hiatus hernia are associated with a better clinical outcome following laparoscopic fundoplication, whereas socioeconomic status does not influence outcome.
抗反流手术对治疗胃食管反流有效，但并非所有患者都能从中同等程度获益。挑战在于识别最终能从抗反流手术中获益的患者。本研究的目的是确定预测抗反流手术后临床结局的术前因素，特别关注社会经济因素的影响。
前瞻性收集了1650例拟行腹腔镜胃底折叠术患者的术前临床和社会经济数据。在短期（1年）和长期（≥3年）随访时评估临床结局指标（持续性烧心、吞咽困难、满意度）。
在早期随访中，男性（相对危险度[RR]1.091，p<0.001）和存在食管裂孔疝（RR 1.065，p=0.002）与烧心减轻独立相关。男性还与更高的总体满意度相关（RR 1.046，p=0.034）。发现术后吞咽困难与年龄（RR 0.988，p=0.007）和不存在食管裂孔疝（RR 0.767，p=0.001）有关。在长期随访中，只有男性（RR 1.125，p<0.001）是烧心控制的独立预后因素。男性（RR 0.761，p=0.001）、存在食管裂孔疝（RR 0.823，p=0.014）和脑血管合并症（RR 1.306，p=0.019）是长期随访时吞咽困难的独立预后因素。食管裂孔疝是与更好的总体满意度相关的唯一因素。社会经济因素在短期和长期随访中均未影响任何临床结局。
男性和食管裂孔疝与腹腔镜胃底折叠术后更好的临床结局相关，而社会经济地位不影响结局。
