van Rijn S, Rinsma N F, van Herwaarden-Lindeboom M Y A, Ringers J, Gooszen H G, van Rijn P J J, Veenendaal R A, Conchillo J M, Bouvy N D, Masclee Adrian A M
Division of Gastroenterology-Hepatology, NUTRIM Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Am J Gastroenterol. 2016 Apr;111(4):508-15. doi: 10.1038/ajg.2016.42. Epub 2016 Mar 15.
Vagus nerve injury is a feared complication of antireflux surgery (ARS) that may negatively affect reflux control. The aim of the present prospective study was to evaluate short-term and long-term impact of vagus nerve injury, evaluated by pancreatic polypeptide response to insulin-induced hypoglycemia (PP-IH), on the outcome of ARS.
In the period from 1990 until 2000, 125 patients with gastroesophageal reflux disease (GERD) underwent ARS at a single center. Before and 6 months after surgery, vagus nerve integrity testing (PP-IH), 24-h pH-monitoring, gastric emptying, and reflux-associated symptoms were evaluated. In 2014, 14-25 years after surgery, 110 patients were contacted again for evaluation of long-term symptomatic outcome using two validated questionnaires (Gastrointestinal Symptom Rating Scale (GSRS) and GERD-Health Related Quality of Life (HRQL)).
Short-term follow-up: vagus nerve injury (PP peak ≤47 pmol/l) was observed in 23 patients (18%) 6 months after fundoplication. In both groups, a comparable decrease in reflux parameters and symptoms was observed at 6-month follow-up. Postoperative gastric emptying was significantly delayed in the vagus nerve injury group compared with the vagus nerve intact group. Long-term follow-up: patients with vagus nerve injury showed significantly less effective reflux control and a higher re-operation rate.
Vagus nerve injury occurs in up to 20% of patients after ARS. Reflux control 6 months after surgery was not affected by vagus nerve injury. However, long-term follow-up showed a negative effect on reflux symptom control and re-operation rate in patients with vagus nerve injury.
迷走神经损伤是抗反流手术（ARS）令人担忧的并发症，可能会对反流控制产生负面影响。本前瞻性研究的目的是评估通过胰岛素诱发低血糖后胰多肽反应（PP-IH）评估的迷走神经损伤对ARS结局的短期和长期影响。
1990年至2000年期间，125例胃食管反流病（GERD）患者在单一中心接受了ARS。在手术前和术后6个月，评估迷走神经完整性测试（PP-IH）、24小时pH监测、胃排空和反流相关症状。2014年，即手术后14至25年，再次联系110例患者，使用两份经过验证的问卷（胃肠道症状评分量表（GSRS）和GERD健康相关生活质量（HRQL））评估长期症状结局。
短期随访：在胃底折叠术后6个月，23例患者（18%）出现迷走神经损伤（PP峰值≤47 pmol/l）。在两组中，6个月随访时反流参数和症状均有类似程度的下降。与迷走神经完整组相比，迷走神经损伤组术后胃排空明显延迟。长期随访：迷走神经损伤患者的反流控制效果明显较差，再次手术率较高。
ARS术后高达20%的患者会发生迷走神经损伤。术后6个月的反流控制不受迷走神经损伤的影响。然而，长期随访显示迷走神经损伤患者的反流症状控制和再次手术率受到负面影响。
