Robinson Ben, Dunst Christy M, Cassera Maria A, Reavis Kevin M, Sharata Ahmed, Swanstrom Lee L
Foundation for Surgical Innovation and Education, Portland, OR, USA,
Surg Endosc. 2015 Sep;29(9):2520-4. doi: 10.1007/s00464-014-4012-x. Epub 2014 Dec 9.
Laparoscopic surgery for gastrointestinal reflux disease was introduced in 1991. Early safety, efficacy, and 5-10-year durability have been amply documented, but long-term patient outcomes have been criticized. This study presents 20-year outcomes after laparoscopic fundoplication (LF) in a consecutive patient cohort.
Patients who underwent primary LF procedures for gastroesophageal reflux disease (GERD) were identified from a prospectively collected IRB-approved database (1991-1995). A phone symptom questionnaire was administered using a 5-point validated GERD scoring system (heartburn, regurgitation, and dysphagia). Symptomatic success was defined by a lack of surgical re-intervention and a low symptom score.
One-hundred and ninety-three patients were identified during the time period. Fifty-one patients completed the survey (100 lost to follow-up, 40 deceased, 2 declined to answer). Respondents had a median follow-up of 19.7 years. Overall, 38/51 (74.5%) of patients reported complete control of heartburn and regurgitation. Ten patients reported only occasional heartburn. Eight of fifty-one (16%) reported daily dysphagia, and 22/51 (43%) of respondents were using proton pump inhibitors at the time of telephone interview. Nine of fifty-one (18%) underwent revision of the original surgery which did not negatively impact the satisfaction rating, with 8/9 (89%) of these patients reporting the highest satisfaction rating. Overall, 46/51 (90%) were satisfied with their choice of surgery.
Long-term results from the early experience with LF are excellent with 94% of patients reporting only occasional or fewer reflux symptoms at 20-year follow-up. However, 18% required surgical revision surgery to maintain their results. There is a relatively high rate of daily dysphagia but 90% of patients are happy to have had LF.
1991年引入了用于治疗胃食管反流病的腹腔镜手术。早期的安全性、有效性以及5至10年的持久性已有大量文献记载，但长期的患者预后受到了批评。本研究呈现了连续患者队列中行腹腔镜胃底折叠术（LF）后的20年预后情况。
从一个前瞻性收集的经机构审查委员会批准的数据库（1991 - 1995年）中识别出因胃食管反流病（GERD）接受初次LF手术的患者。使用经过验证的5分GERD评分系统（烧心、反流和吞咽困难）进行电话症状问卷调查。症状改善成功的定义为无需再次手术干预且症状评分较低。
在此期间共识别出193例患者。51例患者完成了调查（100例失访，40例死亡，2例拒绝回答）。受访者的中位随访时间为19.7年。总体而言，38/51（74.5%）的患者报告烧心和反流得到完全控制。10例患者仅偶尔出现烧心症状。51例中有8例（16%）报告每日存在吞咽困难，22/51（43%）的受访者在电话访谈时正在使用质子泵抑制剂。51例中有9例（18%）接受了原手术的翻修，这并未对满意度评分产生负面影响，其中8/9（89%）的患者报告了最高满意度评分。总体而言，46/51（90%）的患者对其手术选择感到满意。
LF早期经验的长期结果非常好，94%的患者在20年随访时报告仅偶尔出现或更少的反流症状。然而，18%的患者需要进行翻修手术以维持疗效。每日吞咽困难的发生率相对较高，但90%的患者对接受LF手术感到满意。
