Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Pediatr Surg. 2020 Nov;55(11):2408-2412. doi: 10.1016/j.jpedsurg.2019.12.024. Epub 2020 Jan 10.
Aspiration pneumonia is a common and serious complication to gastroesophageal reflux disease (GERD) among neurologically impaired children. Medication of GERD does not effectively prevent aspiration pneumonia, and whether antireflux surgery with fundoplication is better in this respect is uncertain. The objective was to determine whether fundoplication prevents aspiration pneumonia among children with neurological impairment and GERD.
This was a population-based cohort study from Denmark, Finland, Norway and Sweden, consisting of neurologically impaired children with GERD who underwent fundoplication. The risk of aspiration pneumonia before fundoplication (preoperative person-time) was compared with the risk after surgery (postoperative person-time). Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs). Except for confounding adjusted for by means of the "crossover like" design, the HRs were adjusted for age, sex, year of entry and respiratory diseases.
Among 578 patients (median age 3.5 years), the preoperative person-time was 956 years and the postoperative person-time was 3324 years. Fundoplication was associated with 56% decreased overall HR of aspiration pneumonia (HR 0.44, 95% CI 0.27-0.72), and the HRs decreased over time after surgery. The risk of other types of pneumonia than aspiration pneumonia was not clearly decreased after fundoplication (HR 0.79, 95% CI 0.59-1.08). The 30-day mortality rate was 0.7% and the complication rate was 3.6%.
Antireflux surgery decreases, but does not eliminate, the risk of aspiration pneumonia among neurologically impaired children with GERD. Fundoplication may be a treatment option when aspiration pneumonia is a recurrent problem in these children.
Cohort study.
Prognosis study-level I.
吞咽性肺炎是神经损伤儿童胃食管反流病（GERD）的一种常见且严重的并发症。GERD 的药物治疗并不能有效预防吞咽性肺炎，而抗反流手术（胃底折叠术）在这方面是否更好尚不确定。本研究旨在确定胃底折叠术是否可预防神经损伤合并 GERD 的儿童发生吞咽性肺炎。
这是一项来自丹麦、芬兰、挪威和瑞典的基于人群的队列研究，研究对象为接受胃底折叠术的神经损伤合并 GERD 儿童。将手术前（术前人员时间）的吞咽性肺炎风险与手术后（术后人员时间）的风险进行比较。多变量 Cox 回归提供了风险比（HR）及其 95%置信区间（CI）。除了通过“类似交叉”设计调整混杂因素外，HR 还根据年龄、性别、入组年份和呼吸系统疾病进行了调整。
在 578 名患者中（中位年龄 3.5 岁），术前人员时间为 956 年，术后人员时间为 3324 年。胃底折叠术与吞咽性肺炎的总体 HR 降低了 56%（HR 0.44，95%CI 0.27-0.72），且术后 HR 随时间逐渐降低。胃底折叠术并不能明显降低其他类型肺炎（非吞咽性肺炎）的风险（HR 0.79，95%CI 0.59-1.08）。术后 30 天死亡率为 0.7%，并发症发生率为 3.6%。
抗反流手术可降低神经损伤合并 GERD 儿童发生吞咽性肺炎的风险，但不能完全消除该风险。对于这些儿童反复发生吞咽性肺炎的情况，胃底折叠术可能是一种治疗选择。
队列研究。
预后研究Ⅰ级。
