早期胃底折叠术与胃食管反流病患者肺移植后肺功能下降速度较慢相关。

Early fundoplication is associated with slower decline in lung function after lung transplantation in patients with gastroesophageal reflux disease.

机构信息

Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz.

Department of General Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Ariz.

出版信息

J Thorac Cardiovasc Surg. 2018 Jun;155(6):2762-2771.e1. doi: 10.1016/j.jtcvs.2018.02.009. Epub 2018 Feb 13.

DOI:10.1016/j.jtcvs.2018.02.009

PMID:29572022

Abstract

OBJECTIVES

Gastroesophageal reflux disease (GERD) is prevalent after lung transplantation. Fundoplication slows lung function decline in patients with GERD, but the optimal timing of fundoplication is unknown.

METHODS

We retrospectively reviewed patients who underwent fundoplication after lung transplantion at our center from April 2007 to July 2014. Patients were divided into 2 groups: early fundoplication (<6 months after lung transplantation) and late fundoplication (≥6 months after lung transplantation). Annual decline in percent predicted forced expiratory volume in 1 second (FEV) was analyzed.

RESULTS

Of the 251 patients who underwent lung transplantation during the study period with available pH data, 86 (34.3%) underwent post-transplantation fundoplication for GERD. Thirty of 86 (34.9%) had early fundoplication and 56 of 86 (65.1%) had late fundoplication. Median time from lung transplantation to fundoplication was 4.6 months (interquartile range, 2.0-5.2) and 13.8 months (interquartile range, 9.0-16.1) for the early and late groups, respectively. The median DeMeester score was comparable between groups. One-, 3-, and 5-year actuarial survival rates in the early group were 90%, 70%, and 70%, respectively; in the late group, these rates were 91%, 66%, and 66% (log rank P = .60). Three- and 5-year percent predicted FEV was lower in the late group by 8.9% (95% confidence interval, -30.2 to 12.38; P = .46) and 40.7% (95% confidence interval, -73.66 to -7.69; P = .019). A linear mixed model showed a 5.7% lower percent predicted FEV over time in the late fundoplication group (P < .001).

CONCLUSIONS

In this study, patients with early fundoplication had a higher FEV 5 years after lung transplantation. Early fundoplication might protect against GERD-induced lung damage in lung transplant recipients with GERD.

摘要

目的

胃食管反流病（GERD）在肺移植后较为常见。胃底折叠术可减缓 GERD 患者的肺功能下降速度，但胃底折叠术的最佳时机尚不清楚。

方法

我们回顾性分析了 2007 年 4 月至 2014 年 7 月期间在我中心行胃底折叠术的肺移植术后患者。患者分为两组：早期胃底折叠术（肺移植术后<6 个月）和晚期胃底折叠术（肺移植术后≥6 个月）。分析了每年预计 1 秒用力呼气量（FEV）百分比的下降情况。

结果

在研究期间，251 例接受肺移植且有 pH 值数据的患者中，86 例（34.3%）因 GERD 行移植后胃底折叠术。其中 30 例（34.9%）为早期胃底折叠术，56 例（65.1%）为晚期胃底折叠术。从肺移植到胃底折叠术的中位时间分别为 4.6 个月（四分位间距，2.0-5.2）和 13.8 个月（四分位间距，9.0-16.1），早期组和晚期组的中位 DeMeester 评分无差异。早期组的 1 年、3 年和 5 年生存率分别为 90%、70%和 70%，晚期组分别为 91%、66%和 66%（对数秩检验 P=0.60）。晚期组的 3 年和 5 年预计 FEV 百分比分别低 8.9%（95%置信区间，-30.2 至 12.38；P=0.46）和 40.7%（95%置信区间，-73.66 至-7.69；P=0.019）。线性混合模型显示，晚期胃底折叠组的预计 FEV 每年下降 5.7%（P<0.001）。