经口无切口胃底折叠术的长期随访结果：一项 8 年队列研究。
Long-term reported outcomes of transoral incisionless fundoplication: an 8-year cohort study.
机构信息
Department of Surgery, The Ohio State University, Columbus, OH, USA.
Department of Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
出版信息
Surg Endosc. 2019 Apr;33(4):1304-1309. doi: 10.1007/s00464-018-6403-x. Epub 2018 Aug 27.
BACKGROUND
Transoral incisionless fundoplication (TIF) offers an endoscopic approach to the treatment of gastroesophageal reflux disease (GERD). Controlled trials have demonstrated the short-term efficacy of this procedure, but long-term follow-up studies are lacking. The objective of this study was to evaluate the long-term impact of TIF on disease-specific quality of life and antisecretory medication use.
METHODS
We performed retrospective cohort study of all patients undergoing TIF between 2007 and 2014 in a large academic medical center. Reflux symptoms and quality of life were assessed using the gastroesophageal reflux disease health-related quality of life (GERD-HRQL) questionnaire at baseline, short-term, and long-term follow-up.
RESULTS
Fifty-seven patients with a median age of 46 (37-59) years and an average BMI of 28.8 ± 4.9 kg/m underwent TIF during the study period. Sixty percent of the patients were female, and all were taking a PPI at least daily. At a median follow-up interval of 97 months, twelve patients had undergone subsequent laparoscopic antireflux surgery (LARS). Of those who had not, 23 had complete long-term follow-up data for analysis and were included in the study. Seventy-three percent reported daily acid-reducing medication use, and the median GERD-HRQL score was 10 (6-14) compared to 24 (15-28) at baseline (p < 0.01). Seventy-eight percent of these patients expressed satisfaction or neutral feelings about their GERD management. There were no significant differences in the baseline characteristics of patients who underwent LARS during the study period and those who did not.
CONCLUSIONS
This study demonstrates that TIF can produce durable improvements in disease-specific quality of life in some patients with symptomatic GERD. The majority of patients resumed daily PPI therapy during the study period, but with significantly improved GERD-HRQL scores compared to baseline and increased satisfaction with their medical condition.
背景
经口无切口胃底折叠术（TIF）为胃食管反流病（GERD）的治疗提供了一种内镜方法。对照试验已经证实了该手术的短期疗效，但缺乏长期随访研究。本研究的目的是评估 TIF 对疾病特异性生活质量和抗分泌药物使用的长期影响。
方法
我们对 2007 年至 2014 年间在一家大型学术医疗中心接受 TIF 的所有患者进行了回顾性队列研究。在基线、短期和长期随访时，使用胃食管反流病健康相关生活质量（GERD-HRQL）问卷评估反流症状和生活质量。
结果
在研究期间，57 例中位年龄为 46（37-59）岁、平均 BMI 为 28.8±4.9kg/m²的患者接受了 TIF。60%的患者为女性，所有患者均至少每天服用 PPI。在中位随访间隔 97 个月时，有 12 例患者随后接受了腹腔镜抗反流手术（LARS）。在未接受 LARS 的患者中，有 23 例具有完整的长期随访数据进行分析并纳入研究。73%的患者报告每天使用抑酸药物，中位 GERD-HRQL 评分为 10（6-14），而基线时为 24（15-28）（p<0.01）。这些患者中有 78%对他们的 GERD 管理表示满意或中性。在研究期间接受 LARS 的患者和未接受 LARS 的患者的基线特征无显著差异。
结论
本研究表明，TIF 可以在一些有症状的 GERD 患者中产生持久的疾病特异性生活质量改善。大多数患者在研究期间恢复了每天使用 PPI 治疗，但与基线相比，GERD-HRQL 评分显著改善，对他们的病情满意度增加。
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