腹腔镜反流术与胃食道反流的复发之间的关联
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
概括
近五分之一的患者经过腹腔镜反流手术后再次出现反流, 通常需要药物或进一步的手术. 女性性别,年龄和并发症是复发的关键风险因素.
科学领域:
- 胃肠病学
- 手术的结果
- 流行病学
背景情况:
- 之前使用问卷的队列研究报告了反流术后反流的高复发率,这可能会减少其利用率.
- 在未被选择的患者中,对腹腔镜反流术后反流复发的长期,基于人群的数据有限.
研究的目的:
- 评估腹腔镜反流手术后反流的长期风险.
- 在大量患者中确定与反流复发相关的特定风险因素.
主要方法:
- 在瑞典从2005年到2014年进行了全国性的基于人口的回顾性队列研究.
- 在瑞典的健康登记处进行了2655例腹腔镜抗逆流手术的数据.
- 通过长期使用药物或二次抗逆流症手术来确定反流的复发;多变量Cox回归分析了风险因素.
主要成果:
- 总共有2655名患者接受了中位数5. 6年的随访,其中17. 7%的患者出现了反流复发.
- 主要通过长期药物治疗 (83. 6%) 或二次手术 (16. 4%) 来控制复发.
- 确定的复发风险因素包括女性性别 (HR 1.57),年龄较大 (HR 1. 41对于年龄≥61与≤45) 和并发症 (HR 1. 36对于查尔森得分≥1与0).
结论:
- 腹腔镜抗逆流手术与需要持续治疗的复发率 (17. 7%) 有关.
- 年龄,女性性别和并发症是反流复发的重要预测因素.
- 这些发现表明,腹腔镜抗逆流手术的长期益处可能会因复发率大幅下降而减少.
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