Sheu Eric G, Nau Peter, Nath Barbara, Kuo Braden, Rattner David W
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA,
Surg Endosc. 2015 Mar;29(3):505-9. doi: 10.1007/s00464-014-3704-6. Epub 2014 Jul 11.
Laparoscopic magnetic sphincter augmentation (MSA) with the LINX device is a promising new therapy for the treatment of gastroesophageal reflux disease (GERD). Initial studies have demonstrated MSA to be safe and effective. However, no direct comparison between MSA and laparoscopic Nissen fundoplication (LNF), the gold standard surgical therapy for GERD, has been performed.
A single institution, case-control study was conducted of MSA performed from 2012 to 2013 and a cohort of LNF matched for age, gender, and hiatal hernia size.
MSA and LNF were both effective treatments for reflux with 75 and 83 % of patients, respectively, reporting resolution of GERD at short-term follow-up. Dysphagia was common following both MSA and LNF, but severe dysphagia requiring endoscopic dilation was more frequent after MSA (50 vs. 0 %, p = 0.01). Need for dilation did not correlate with size of the LINX device or any other examined patient factors. A trend toward decreased adverse GI symptoms of bloating, flatulence, and diarrhea was seen after MSA compared to LNF (0 vs. 33 %). MSA had a shorter operative time (64 vs. 90 min, p < 0.01) but other peri-operative outcomes, including pain, morbidity, and re-admissions were equivalent to LNF. MSA patients were more likely to be self-referred (58 vs. 0 %, p < 0.001).
MSA and LNF are both effective and safe treatments for GERD; however, severe dysphagia requiring endoscopic intervention is more common with MSA. Other adverse GI side effects may be less frequent after MSA. Consideration should be paid to these distinct post-operative symptom profiles when selecting a surgical therapy for reflux disease.
使用LINX装置进行腹腔镜磁括约肌增强术（MSA）是一种治疗胃食管反流病（GERD）的有前景的新疗法。初步研究已证明MSA安全有效。然而，尚未对MSA与GERD的金标准手术疗法——腹腔镜Nissen胃底折叠术（LNF）进行直接比较。
对2012年至2013年进行的MSA以及一组年龄、性别和食管裂孔疝大小相匹配的LNF患者进行了单机构病例对照研究。
MSA和LNF都是治疗反流的有效方法，分别有75%和83%的患者在短期随访中报告GERD症状得到缓解。MSA和LNF术后吞咽困难都很常见，但MSA后需要内镜扩张的严重吞咽困难更频繁（50%对0%，p = 0.01）。扩张需求与LINX装置的大小或任何其他检查的患者因素无关。与LNF相比，MSA后腹胀、肠胃胀气和腹泻等不良胃肠道症状有减少的趋势（0%对33%）。MSA的手术时间较短（64分钟对90分钟，p < 0.01），但其他围手术期结果，包括疼痛、发病率和再次入院情况与LNF相当。MSA患者更有可能是自行转诊的（58%对0%，p < 0.001）。
MSA和LNF都是治疗GERD的有效且安全的方法；然而，MSA后需要内镜干预的严重吞咽困难更常见。MSA后的其他不良胃肠道副作用可能较少。在选择反流病的手术治疗方法时，应考虑这些不同的术后症状特征。
