胃食道逆流手術と胃食道逆流の再発との関連
John Maret-Ouda1, Karl Wahlin1, Hashem B El-Serag2,3
1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
JAMA
|September 13, 2017
まとめ
患者の5分の"近くが 腹腔鏡による反流症対策手術後に再発し 薬剤やさらなる手術が必要になります 女性の性別,年長,併発症は再発の主要な危険因子です.
科学分野:
- 胃腸内科
- 手術 の 結果
- 流行病学
背景:
- 前回のコホート研究では,アンチ・リフルス手術後の高頻度のリフルス再発が報告され,その利用率が低下した可能性がある.
- 未選択の患者の腹腔鏡による反流手術後の反流再発に関する長期的,集団ベースのデータは限られている.
研究 の 目的:
- 腹腔鏡による反流手術後の反流再発の長期的リスクを評価する.
- 大規模な患者集団における反流再発に関連する特定の危険因子を特定する.
主な方法:
- スウェーデンでは2005年から2014年にかけて 全国規模で人口を対象とした遡及コホート研究が行われました.
- 主要な腹腔鏡による反流性外科手術を受けた2655人の患者のデータをスウェーデンの健康記録にリンクした.
- リフルス再発は,長期の薬物使用または二次反リフルス手術によって定義され,多変量コックス回帰はリスク要因を分析した.
主要な成果:
- 合計2655人の患者が平均5. 6年間追跡され,17%が再発した.
- 再発は主に長期治療 (83. 6%) または二次手術 (16. 4%) で管理された.
- 再発の危険因子には,女性 (HR1. 57),高齢者 (HR1. 41),および併発性 (HR1. 36 チャールソンスコア ≥1 対 0) が含まれていた.
結論:
- ラパロスコープによる抗逆流症手術は,継続的な治療を必要とする,有意な再発率 (17. 7%) と関連しています.
- 高齢,女性,併発性疾患はリフルス再発の重要な予測因子です.
- 研究結果は,腹腔鏡による反流性外科手術の長期的利益は,重発率が高いため,減少する可能性があることを示唆している.
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