DeMaria E J, Siuta M, Widmeyer J, Zfass A M
Department of Surgery, Medical College of Virginia, Richmond, USA.
Gastroenterologist. 1997 Mar;5(1):85-93.
The advent of the laparoscopic approach to Nissen fundoplication has led to a resurgence in enthusiasm for the surgical treatment of gastroesophageal reflux disease (GERD). However, controversy exists as to which subgroups of GERD patients are best treated surgically. The relative success of treatment with medical and surgical intervention in terms of both symptom control and objective resolution of esophageal injury must be weighed against the relative costs of each therapeutic strategy in both the short and long term, given that GERD tends to be a lifelong disorder. The following is the transcribed text of a debate held at the Medical College of Virginia as part of a continuing medical education program in which the statement "Laparoscopic antireflux surgery is superior to medical treatment for severe gastroesophageal reflux disease" was contested. Representatives from the departments of surgery and gastroenterology provided arguments supporting their respective sides of this issue. The purpose was not to promote polarization in treatment selection, but to review the available data in a forum that could promote development of a rational algorithm for clinical decision-making in patients with GERD who might benefit from antireflux surgery. Final comments from the authors are provided in an attempt to synthesize the arguments into a reasonable strategy for individual case management.
腹腔镜下尼氏胃底折叠术的出现，使得人们对胃食管反流病（GERD）的手术治疗热情再度高涨。然而，对于哪些GERD患者亚组最适合手术治疗仍存在争议。鉴于GERD往往是一种终身性疾病，在短期和长期内，必须权衡药物治疗和手术干预在症状控制以及食管损伤客观缓解方面的相对成功率与每种治疗策略的相对成本。以下是弗吉尼亚医学院举行的一场辩论的文字记录，该辩论是继续医学教育项目的一部分，其中“腹腔镜抗反流手术优于重度胃食管反流病的药物治疗”这一观点受到了质疑。外科和胃肠病学部门的代表提供了支持各自立场的论据。目的并非促进治疗选择的两极分化，而是在一个能够促进为可能受益于抗反流手术的GERD患者制定合理临床决策算法的论坛上，回顾现有数据。作者给出了最终评论，试图将这些论据综合成一个针对个体病例管理的合理策略。
