胃食管反流病(GERD)是儿童常见病。当药物治疗失败时,考虑腹腔镜抗反流手术(LARS)。短期随访研究报告成功率很高;然而,很少有研究报告长期结果。这项研究的目的是描述LARS对儿科患者的长期影响。
有前景的,对25例腹腔镜胃底折叠术患者进行了多中心研究。术后3个月和1、2和5年,患者和护理人员被要求填写胃食管反流症状问卷以评估症状,并填写PedsQL™以评估健康相关生活质量(HRQoL).
与术前水平相比,LARS后5年的反流症状严重程度仍有明显改善(p<0.0001)。然而,26%的患者报告了中度或重度反流症状。LARS后5年,有13%的患者报告吞咽困难,在患有神经系统障碍的儿童和接受Nissen手术的儿童中更为常见。术后3个月HRQoL的增加似乎随着时间的推移而下降:手术后5年,HRQoL较低,虽然不重要,术后3个月以上。5年的HRQoL仍然较高,虽然也不重要,高于术前水平。术后出现反流症状与较低的HRQoL无显著相关性。
LARS对儿童难治性GERD有效。手术五年后,反流症状仍有改善。然而,我们观察到无症状患者随时间减少.在LARS之后不久,HRQoL的最初增加似乎随着时间的推移而下降。
荷兰国家审判注册标识符:2934(www.trialregister.nl)。
Gastroesophageal reflux disease (GERD) is a common disease in children. When drug treatment fails, laparoscopic anti-reflux surgery (LARS) is considered. Short-term follow-up studies report high success rates; however, few studies report long-term results. The aim of this
study was to describe the long-term effects of LARS in pediatric patients.
A prospective, multicenter
study of 25 laparoscopic fundoplication patients was performed. At 3 months and 1, 2, and 5 years postoperatively, patients and caregivers were asked to complete the gastroesophageal reflux symptom questionnaire to assess symptoms and the PedsQL™ to assess health-related quality of life (HRQoL).
Reflux symptom severity was still significantly improved 5 years after LARS compared with preoperative levels (p < 0.0001). However, 26% of patients reported moderate or severe reflux symptoms. Dysphagia was reported in 13% of patients 5 years after LARS and was more common in children with neurologic impairment and children who underwent a Nissen procedure. The increase in HRQoL 3 months postoperatively appears to decline over time: 5 years after surgery, HRQoL was lower, though not significantly, than 3 months postoperatively. HRQoL at 5 years was still higher, though also not significantly, than preoperative levels. The presence of reflux symptoms after surgery was not significantly associated with lower HRQoL.
LARS is effective for therapy-resistant GERD in children. Five years after surgery, reflux symptoms are still improved. However, we observed a decline in symptom-free patients over time. The initial increase in HRQoL shortly after LARS appears to decline over time.
Dutch national
trial registry Identifier: 2934 ( www.trialregister.nl ).