固定式不變形基底摺疊術對GERD有最佳結果


  【24drs.com】根據一篇前瞻臨床試驗結果,完整的固定式不變形基底摺疊術,發生胃食道逆流(GERD)的長期復發率比Nissen氏手術或部分基底摺疊術還低。
  
  墨西哥市GEA醫院的Moreno Mucio醫師等人在2012年1月的外科期刊發表了他們的研究發現。
  
  作者們指出,雖然顯示出抗逆流的效果,但是還有其他問題。作者們寫道,有許多抗逆流手術併發症,例如吞嚥困難、吞嚥疼痛、腹脹、腹瀉、穿孔、感染等等,相當高比率的病患會症狀復發。
  
  這篇研究中,作者們招募了512名胃食道逆流病患,將其隨機分為四組(部份手術、Nissen氏手術、固定式不變形手術、藥物治療),並追蹤15年。完成15年追蹤的319名病患中,固定式不變形手術的胃食道逆流症發生率最低(固定式不變形手術、Nissen氏手術、部份手術、藥物治療之盛行率分別為7.20%、21.56%、39.80%和47.05%;P < .01)。
  
  作者們納入的病患年紀至少18歲,有典型的胃食道逆流症狀與黏膜損傷、下食道括約肌休息時壓力小於10 mm Hg,作者們排除了相關共病症患者、接受內視鏡或外科減重手術者、接受食道或胃部手術者。
  
  追蹤15年後,部分手術組與固定式不變形手術組的下食道括約肌長度比Nissen氏手術組長(2.06公分、2.26公分和0.74公分;P < .01);追蹤結束時,固定式不變形手術組的下食道括約肌壓力顯著高於其他組(固定式不變形手術組、Nissen氏手術組、部分手術組、藥物治療組分別是14.7、9、7.17和5.64 mm Hg;P < .01)。固定式不變形手術組在追蹤15年後的復發逆流(定義為DeMeester分數 > 14.7)人數最少(固定式不變形手術組、Nissen氏手術組、部分手術組分別是13.6%、37%和87%;P < .01)。
  
  作者們認為,他們的研究結果指出了固定式不變形手術技術的安全性與效果。固定式不變形基底摺疊術是有效的、安全的、可行的抗逆流腹腔鏡手術。下食道括約肌的持久改變和長久地重建生活品質有關。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6679&x_classno=0&x_chkdelpoint=Y
  

Best GERD Results From Fixed Nondeformable Fundoplication

By Joe Barber, Jr, PhD
Medscape Medical News

December 14, 2011 — The complete fixed "nondeformable" fundoplication resulted in a lower long-term recurrence of gastroesophageal reflux disease than the Nissen and partial fundoplication techniques, according to the findings of a prospective clinical trial.

Moreno Mucio, MD, from GEA Hospital in Mexico City, Mexico, and colleagues published their findings in the January 2012 issue of Surgery.

Despite the demonstrated efficacy of antireflux surgery, the authors note that many issues remain. "There are several antireflux surgery complications, such as dysphagia, odynophagia, abdominal bloating, diarrhea, perforation, infection, and so on, and a significant percentage of patients may develop recurrent symptoms," the authors write.

In this study, the authors recruited 512 patients with gastroesophageal reflux disease who were randomly assigned to 1 of 4 treatment groups (partial, Nissen, fixed nondeformable, and medical treatment) and followed for 15 years. Among the 319 patients who completed the 15-year follow-up, the lowest incidence of gastroesophageal reflux disease was observed in the fixed nondeformable group (prevalence, 7.20%, 21.56%, 39.80%, and 47.05% for the fixed nondeformable, Nissen, partial, and medical treatment groups, respectively; P < .01).

The authors included patients who were at least 18 years old and had typical symptoms of gastroesophageal reflux disease and mucosal injury and lower esophageal sphincter resting pressure of less than 10 mm Hg. The authors excluded patients with associated comorbidity, those who underwent endoscopic or surgical obesity procedures, and those who underwent esophageal or stomach surgery.

The partial and fixed nondeformable groups exhibited greater lower esophageal sphincter length than the Nissen group after 15 years of follow-up (2.06 cm, 2.26 cm, and 0.74 cm for the partial, fixed nondeformable, and Nissen groups, respectively; P < .01). At the end of follow-up, lower esophageal sphincter pressure was significantly higher in the fixed nondeformable group than in the other groups (14.7, 9, 7.17, and 5.64 mm Hg for the fixed nondeformable, Nissen, partial, and medical treatment groups, respectively; P < .01). The fixed nondeformable group exhibited a significantly lower proportion of individuals with recurrent reflex (DeMeester score > 14.7) after 15 years of follow-up (13.6%, 37%, and 87% for the fixed nondeformable, Nissen, and partial groups, respectively; P < .01).

The authors suggest that their findings illustrate the safety and efficacy of the fixed nondeformable fundoplication technique. "The fixed 'nondeformable' fundoplication is an effective, safe, and feasible antireflux laparoscopic procedure," the authors write. "Permanent changes achieved at the [lower esophageal sphincter] are associated with long-lasting, restored quality of life."

The authors have disclosed no relevant financial relationships.

Surgery. 2011;151:84-93.

    
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