Parker David M, Rambhajan Amrit A, Horsley Ryan D, Johanson Kathleen, Gabrielsen Jon D, Petrick Anthony T
Department of Surgery, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA.
Surg Endosc. 2017 Mar;31(3):1186-1191. doi: 10.1007/s00464-016-5089-1. Epub 2016 Jul 15.
Paraesophageal hernias (PEHs) occur frequently in the elderly. Patients may not be referred for repair due to age or concern for high operative morbidity and mortality. The aim of this study was to compare outcomes of PEH repair based on age.
Adult patients undergoing PEH repair between 2003 and 2012 at a tertiary referral center were included. Patients were divided by age (Y < 69, YO 70-79 and VO > 80). Body mass index (BMI), Charlson comorbidity index, operative time, estimated blood loss, length of stay, recurrence, Quality of Life in Reflux and Dyspepsia Questionnaire (QOLRAD) scores, morbidity and mortality were analyzed.
Two hundred and sixty-seven patients were included: Group Y N = 140 (median age 58.5); Group YO N = 82 (median age 75.0); and Group VO N = 45 (median age 83.0). Group Y had a significantly lower age-adjusted Charlson score compared to the older groups. Group VO had significantly lower BMIs compared to Groups Y and YO. Both groups had similar operative times, intraoperative blood loss and rates of Collis gastroplasty. Group Y had significantly less acute presentations compared to the elderly groups YO 12.2 %, p = 0.028, and VO 22.2 %, p = <0.001. Group Y had a smaller percentage of intrathoracic stomach (55.7 %) as compared to Groups YO (65.1 %; p = 0.001) and VO (74.3 %; p = < 0.001). There were no significant differences in mortalities between all three groups. The mean length of hospital stay was significantly shorter in Group Y (2.45) than in both Group YO (3.12; p = 0.001) and Group VO (5.13; p = <0.001). Major morbidity was significantly lower in the younger group 3.6 % when compared to Group VO (17.8 %; p = 0.001). All groups demonstrated significant improvement in QOLRAD scores.
The decision to perform laparoscopic paraesophageal hernia repair (LPEHR) in elderly patients remains challenging. LPEHR can be done safely and effectively in elderly patients at experienced centers.
食管旁疝（PEH）在老年人中很常见。由于年龄或担心手术并发症发生率和死亡率高，患者可能不会被转诊进行修复。本研究的目的是比较基于年龄的PEH修复结果。
纳入2003年至2012年在一家三级转诊中心接受PEH修复的成年患者。患者按年龄分组（Y组<69岁，YO组70 - 79岁，VO组>80岁）。分析体重指数（BMI）、查尔森合并症指数、手术时间、估计失血量、住院时间、复发率、反流和消化不良生活质量问卷（QOLRAD）评分、并发症和死亡率。
共纳入267例患者：Y组N = 140例（中位年龄58.5岁）；YO组N = 82例（中位年龄75.0岁）；VO组N = 45例（中位年龄83.0岁）。与老年组相比，Y组年龄调整后的查尔森评分显著更低。与Y组和YO组相比，VO组的BMI显著更低。两组的手术时间、术中失血量和科利斯胃成形术发生率相似。与老年组YO（12.2%，p = = 0.028）和VO（22.2%，p = <0.001）相比，Y组的急性表现显著更少。与YO组（65.1%；p = 0.001）和VO组（74.3%；p = <0.001）相比，Y组胸腔内胃的比例更小（55.7%）。三组之间的死亡率无显著差异。Y组的平均住院时间（2.45天）显著短于YO组（3.12天；p = 0.001）和VO组（5.13天；p = <0.001）。与VO组（17.8%；p = 0.001）相比，年轻组的主要并发症显著更低（3.6%）。所有组的QOLRAD评分均有显著改善。
决定对老年患者进行腹腔镜食管旁疝修补术（LPEHR）仍然具有挑战性。在经验丰富的中心，老年患者可以安全有效地进行LPEHR。
