磁括约肌增强术治疗大型食管裂孔疝患者的疗效
Efficacy of magnetic sphincter augmentation in patients with large hiatal hernias.
作者信息
Rona Kais A, Reynolds Jessica, Schwameis Katrin, Zehetner Joerg, Samakar Kamran, Oh Paul, Vong David, Sandhu Kulmeet, Katkhouda Namir, Bildzukewicz Nikolai, Lipham John C
机构信息
Keck School of Medicine of USC, Los Angeles, CA, USA.
Department of General Surgery, Keck Hospital of USC, 1510 San Pablo St., HCC Suite 514, Los Angeles, CA, 90033, USA.
出版信息
Surg Endosc. 2017 May;31(5):2096-2102. doi: 10.1007/s00464-016-5204-3. Epub 2016 Aug 23.
BACKGROUND
Magnetic sphincter augmentation (MSA) has demonstrated long-term safety and efficacy in the treatment of patients with gastroesophageal reflux (GERD), but its efficacy in patients with large hiatal hernias has yet to be proven. The aim of our study was to assess outcomes of MSA in patients with hiatal hernias ≥3 cm.
METHODS
We retrospectively reviewed all patients who underwent MSA at our institutions over a 6-year period. Information obtained consisted of patient demographics, symptoms of GERD, preoperative GERD Health-Related Quality-of-Life (HRQL) scores, perioperative details, and implantation of the MSA device. Primary endpoints included postoperative GERD-HRQL scores, proton-pump inhibitor (PPI) use, symptom change, and procedure-related complications. A large hiatal hernia was defined as a hernia measuring ≥3 cm by intraoperative measurement.
RESULTS
A total of 192 patients were reviewed. Median follow-up was 20 months (3-75 months). Mean GERD-HRQL scores in the overall population before and after MSA were 18.9 and 5.0, respectively (p < 0.001). In the majority of patients symptoms improved or resolved (N = 177, p < 0.001). Fifty-two patients (27.0 %) had a hiatal hernia ≥3 cm (range 3-7 cm). Their mean GERD-HRQL score decreased from 20.5 to 3.6 (p < 0.001) following MSA. When compared to patients with smaller hernias, patients with large hiatal hernias had decreased postoperative PPI requirement (9.6 vs. 26.6 %, p = 0.011) and lower mean postoperative GERD-HRQL scores (3.6 vs. 5.6, p = 0.027). The percent of patients requiring postoperative intervention for dysphagia was similar (13.5 vs. 17.9 %, p = 0.522), as was the incidence of symptom resolution or improvement (98.1 vs. 91.3 %, p = 0.118).
CONCLUSION
MSA in patients with large hiatal hernias demonstrates decreased postoperative PPI requirement and mean GERD-HRQL scores compared to patients with smaller hernias. The incidence of symptom resolution or improvement and the percentage of patients requiring intervention for dysphagia are similar. Short-term outcomes of MSA are encouraging in patients with gastroesophageal reflux disease and large hiatal hernias.
背景
磁括约肌增强术（MSA）已证明在治疗胃食管反流（GERD）患者中具有长期安全性和有效性，但其在大裂孔疝患者中的疗效尚未得到证实。我们研究的目的是评估MSA在裂孔疝≥3 cm患者中的治疗效果。
方法
我们回顾性分析了6年间在我们机构接受MSA治疗的所有患者。获取的信息包括患者人口统计学资料、GERD症状、术前GERD健康相关生活质量（HRQL）评分、围手术期详细情况以及MSA装置的植入情况。主要终点包括术后GERD-HRQL评分、质子泵抑制剂（PPI）使用情况、症状变化以及与手术相关的并发症。大裂孔疝定义为术中测量疝大小≥3 cm。
结果
共纳入192例患者进行分析。中位随访时间为20个月（3 - 75个月）。MSA前后总体人群的平均GERD-HRQL评分分别为18.9和5.0（p < 0.001）。大多数患者症状改善或缓解（N = 177，p < 0.001）。52例患者（27.0%）存在≥3 cm的裂孔疝（范围3 - 7 cm）。MSA后，他们的平均GERD-HRQL评分从20.5降至3.6（p < 0.001）。与疝较小的患者相比，大裂孔疝患者术后PPI需求降低（9.6%对26.6%，p = 0.011），术后平均GERD-HRQL评分更低（3.6对5.6，p = 0.027）。吞咽困难需要术后干预的患者比例相似（13.5%对17.9%，p = 0.522），症状缓解或改善的发生率也相似（98.1%对91.3%，p = 0.118）。
结论
与疝较小的患者相比，大裂孔疝患者接受MSA治疗后，术后PPI需求和平均GERD-HRQL评分降低。症状缓解或改善的发生率以及吞咽困难需要干预的患者比例相似。MSA对胃食管反流病和大裂孔疝患者的短期治疗效果令人鼓舞。
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