胃食管反流病的外科治疗
Surgical Treatment of Gastroesophageal Reflux Disease.
作者信息
Schlottmann Francisco, Herbella Fernando A, Allaix Marco E, Rebecchi Fabrizio, Patti Marco G
机构信息
Department of Surgery and Center for Esophageal Diseases and Swallowing, University of North Carolina, 4030 Burnett-Womack Building, Campus Box 7081, Chapel Hill, NC, 27599-7081, USA.
Department of Surgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil.
出版信息
World J Surg. 2017 Jul;41(7):1685-1690. doi: 10.1007/s00268-017-3955-1.
BACKGROUND
Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the USA, and its prevalence is increasing worldwide. Lifestyle modifications and proton pump inhibitors (PPI) therapy are effective in the majority of patients and remain the mainstay of treatment of GERD. However, some patients will need surgical intervention because they have partial control of symptoms, do not want to be on long-term medical treatment, or suffer complications related to PPI therapy.
AIMS
The aim of this study was to review the available evidence that supports laparoscopic antireflux surgery, and to study the effect of surgical therapy on the natural history of GERD.
RESULTS
The key elements for the success of antireflux surgery are proper patient selection, careful analysis of the indications for surgery, complete pre-operative work-up, and proper execution of the surgical technique.
CONCLUSIONS
When the key elements are respected, antireflux surgery is very effective in controlling GERD, and it is associated to minimal morbidity and mortality.
背景
据估计，美国有20%的人口患有胃食管反流病（GERD），且其在全球的患病率正在上升。生活方式的改变和质子泵抑制剂（PPI）治疗对大多数患者有效，仍是GERD治疗的主要手段。然而，一些患者需要手术干预，因为他们的症状只能部分得到控制，不想长期接受药物治疗，或者患有与PPI治疗相关的并发症。
目的
本研究的目的是回顾支持腹腔镜抗反流手术的现有证据，并研究手术治疗对GERD自然病程的影响。
结果
抗反流手术成功的关键因素包括正确的患者选择、对手术适应症的仔细分析、完整的术前检查以及手术技术的正确实施。
结论
如果遵循关键因素，抗反流手术在控制GERD方面非常有效，且其发病率和死亡率极低。
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