Oh Chaeyoun, Youn Joong Kee, Han Ji-Won, Kim Hyun-Young, Jung Sung-Eun
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Department of Pediatric Surgery, Children's Hospital, Seoul National University, 101 Daehang-ro, Yeongeon-dong, Jongno-gu, Seoul, 03080, Korea.
World J Surg. 2018 May;42(5):1463-1468. doi: 10.1007/s00268-017-4276-0.
Neurologically impaired children (NIC) often experience swallowing difficulties and gastroesophageal reflux disease (GERD). Although these conditions could place children in a state of poor nutritional status and prevent them from thriving, there is insufficient research evaluating growth and nutritional status following fundoplication in these patients.
This is a retrospective study of patients who were neurologically impaired and underwent Nissen fundoplication between April 2001 and March 2015. Seventy-six patients were enrolled, and the follow-up period was 12 months or longer. Growth was measured by the change in body weight and height. Nutritional status was measured by the change in body mass index, serum albumin and protein level.
Median age at operation was 1.85 years old, and median body weight was 10 kg. The respective Z scores for weight and height showed significant improvements after 1 year since the operation compared to 1 year within the operation (-2.42 ± 2.19 vs. -1.31 ± 1.96, P < 0.001) (-1.6 ± 2.16 vs. -1.05 ± 1.69, P = 0.002). The respective Z scores for body mass index, albumin and protein also showed improvements after 1 year since the operation compared to 1 year within the operation (-2.07 ± 2.99 vs. -0.89 ± 2.1, P < 0.001) (3.55 ± 0.48 vs. 3.86 ± 0.45, P < 0.001) (6.22 ± 0.76 vs. 6.65 ± 0.51, P < 0.001). Hospital visitation scores associated with reflux were significantly lower after the operation (4.1 ± 3.43 vs. 1.18 ± 1.67, P < 0.001).
In summary, after Nissen fundoplication in NIC with GER, growth and nutritional status improved significantly. Also, hospital visitation scores associated with reflux decreased after the operation.
神经功能受损儿童（NIC）常出现吞咽困难和胃食管反流病（GERD）。尽管这些情况可能使儿童处于营养状况不佳的状态并阻碍其茁壮成长，但对于这些患者行胃底折叠术后生长及营养状况的评估研究不足。
这是一项对2001年4月至2015年3月间神经功能受损并接受nissen胃底折叠术患者的回顾性研究。纳入76例患者，随访期为12个月或更长时间。通过体重和身高的变化来衡量生长情况。通过体重指数、血清白蛋白和蛋白质水平的变化来衡量营养状况。
手术时的中位年龄为1.8五岁，中位体重为10千克。与手术1年内相比，术后1年体重和身高的Z评分分别有显著改善（-2.42±2.19对-1.31±1.96，P<0.001）（-1.6±2.16对-1.05±1.69，P=0.002）。与手术1年内相比，术后1年体重指数、白蛋白和蛋白质的Z评分也有改善（-2.07±2.99对-0.89±2.1，P<0.001）（3.55±0.48对3.86±0.45，P<0.001）（6.22±0.76对6.65±0.51，P<0.001）。术后与反流相关的住院评分显著降低（4.1±3.43对1.18±1.67，P<0.001）。
总之，在患有GER的NIC中行nissen胃底折叠术后，生长和营养状况显著改善。此外，术后与反流相关的住院评分降低。
