Neuvonen P, Sand J, Matikainen M, Rantanen T
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
Päijät-Häme Central Hospital, Lahti, Finland.
World J Surg. 2017 Aug;41(8):2046-2052. doi: 10.1007/s00268-017-3924-8.
A substantial number of people are suffering from gastroesophageal reflux disease (GERD). The indication for surgical treatment is the failure of medical treatment in patients with objectively verified GERD. The use of PPIs has been noted to increase with the length of follow-up after fundoplication, raising questions concerning the durability of surgical results. The aim of the study was to investigate the results of open Nissen fundoplication (ONF) over a follow-up of more than 31 years.
ONF was performed for 38 consecutive patients. Questionnaires concerning long-term outcome were sent on December 14, 2015, to the 24 patients still living. Long-term symptom evaluation was carried out using the Gastrointestinal Symptom Rating Scale (GSRS), Visick grading, a Visual Analog Scale (VAS), the DeMeester-Johnson reflux scale, and the 15D tool.
Seventeen (70.8%) of the 24 patients still living participated in the study. The typical symptoms of GERD had resolved significantly. Dysphagia was graded as none or minimal by 13 (81.3%) patients. The mean 15D score of the patient group was clinically and statistically the same (0.896 vs. 0.899) as that of the age- and sex-standardized general population (p = 0.912). Six (15.8%) patients had used antireflux medication after the operation and 4 of them (10.6%) continuously.
Patients in the present study used PPIs less frequently than what has been reported in previous long-term follow-up studies. Our results indicate that successful surgery may provide lifelong relief of GERD symptoms and normalize the health-related quality of life in GERD patients.
大量人群患有胃食管反流病（GERD）。手术治疗的指征是经客观证实的GERD患者药物治疗失败。有人指出，在胃底折叠术后，质子泵抑制剂（PPI）的使用随随访时间延长而增加，这引发了关于手术效果持久性的问题。本研究的目的是调查开放Nissen胃底折叠术（ONF）超过31年随访期的结果。
连续对38例患者实施ONF。2015年12月14日，向仍在世的24例患者发送了有关长期结果的问卷。使用胃肠道症状评分量表（GSRS）、Visick分级、视觉模拟量表（VAS）、DeMeester-Johnson反流量表和15D工具进行长期症状评估。
仍在世的24例患者中有17例（70.8%）参与了研究。GERD的典型症状已显著缓解。13例（81.3%）患者的吞咽困难分级为无或轻微。患者组的平均15D评分在临床和统计学上与年龄和性别标准化的普通人群相同（0.896对0.899）（p = 0.912）。6例（15.8%）患者术后使用了抗反流药物，其中4例（10.6%）持续使用。
本研究中的患者使用PPI的频率低于先前长期随访研究中的报道。我们的结果表明，成功的手术可能使GERD症状得到终身缓解，并使GERD患者与健康相关的生活质量恢复正常。
