Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin.
Department of Surgery, University of Wisconsin-Madison, Clinical Science Center, Madison, Wisconsin; Department of Surgery, William S. Middleton VA, Madison, Wisconsin.
J Surg Res. 2019 Mar;235:52-57. doi: 10.1016/j.jss.2018.09.036. Epub 2018 Oct 23.
BACKGROUND: Laparoscopic fundoplication is the gold standard operation for treatment of gastroesophageal reflux disease (GERD). It has been suggested that persistent postoperative dysphagia is increased following Nissen fundoplication compared to partial fundoplication. This study aimed to determine risk factors for persistent postoperative dysphagia, specifically examining the type of fundoplication. METHODS: Patients experiencing GERD symptoms who underwent laparoscopic Nissen, Toupet, or Dor fundoplication from 2009 to 2016 were identified from a single-institutional database. A dysphagia score was obtained as part of the GERD health-related quality of life questionnaire. Persistent dysphagia was defined as a difficulty swallowing score ≥1 (noticeable) on a scale from 0 to 5 at least 1 y postoperatively. Odds ratios of persistent dysphagia among those who underwent antireflux surgery were calculated in a multivariate logistic regression model adjusted for fundoplication type, sex, age, body mass index, and redo operation. RESULTS: Of the 441 patients who met inclusion criteria, 255 had ≥1 y of follow-up (57.8%). The median duration of follow-up was 3 y. In this cohort, 45.1% of patients underwent Nissen fundoplication and 54.9% underwent partial fundoplication. Persistent postoperative dysphagia was present in 25.9% (n = 66) of patients. On adjusted analysis, there was no statistically significant association between the type of fundoplication (Nissen versus partial) and the likelihood of postoperative dysphagia. CONCLUSIONS: Persistent postoperative dysphagia after antireflux surgery occurred in approximately one-quarter of patients and did not differ by the type of fundoplication. These findings suggest that both Nissen and partial fundoplication are reasonable choices for an antireflux operation for properly selected patients.
背景:腹腔镜胃底折叠术是治疗胃食管反流病(GERD)的金标准手术。有研究表明,与部分胃底折叠术相比,Nissen 胃底折叠术后持续性术后吞咽困难的发生率更高。本研究旨在确定持续性术后吞咽困难的危险因素,特别是检查胃底折叠术的类型。
方法:从单一机构数据库中确定了 2009 年至 2016 年间接受腹腔镜 Nissen、Toupet 或 Dor 胃底折叠术的 GERD 症状患者。吞咽困难评分作为 GERD 健康相关生活质量问卷的一部分获得。持续性吞咽困难定义为术后至少 1 年时吞咽困难评分≥1(明显),评分范围为 0 至 5。在多变量逻辑回归模型中,对接受抗反流手术的患者进行调整,以计算持续性吞咽困难的比值比,该模型调整了胃底折叠术类型、性别、年龄、体重指数和再次手术。
结果:在符合纳入标准的 441 名患者中,有 255 名患者的随访时间≥1 年(57.8%)。该队列的中位随访时间为 3 年。在该队列中,45.1%的患者接受了 Nissen 胃底折叠术,54.9%的患者接受了部分胃底折叠术。66 例(25.9%)患者存在术后持续性吞咽困难。在调整分析中,胃底折叠术类型(Nissen 与部分)与术后吞咽困难的可能性之间无统计学显著关联。
结论:抗反流手术后约四分之一的患者出现持续性术后吞咽困难,与胃底折叠术类型无关。这些发现表明,对于选择合适的患者,Nissen 和部分胃底折叠术都是合理的抗反流手术选择。
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