Long-term outcome of antireflux surgery in patients with Barrett's esophagus
Long-term outcome of antireflux surgery in patients with Barrett's esophagus
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DOI：
10.1097/00000658-200110000-00012
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发表时间：
2001-10-01
影响因子：
9
通讯作者：
Bremmer, CG
中科院分区：
文献类型：
--
作者：
Hofstetter, WL;Peters, JH;Bremmer, CG
目的评估Barrett食管患者抗反流手术的长期疗效。背景资料摘要Barrett食管的患病率不断增加，其治疗存在问题。抗反流手术有可能阻止反流并诱导粘膜静止。然而，其长期结果最近受到反流控制不佳和无法预防癌症进展的报道的挑战。方法对 97 名巴雷特食管患者进行了抗反流手术的结果研究。随访完成率为 88% (85/97)，中位随访时间为 5 年。 59 个有长节段，26 个有短节段 Barrett。贲门肠化生患者被排除。 50 名患者接受了腹腔镜手术，20 名患者接受了经胸手术，3 名患者接受了腹部 Nissen 手术。九人接受了 Collis-Belsey 手术，三人接受了其他部分包扎手术。结果测量包括反流症状的缓解（全部）、患者对结果的感知（全部）、上消化道内窥镜检查和组织学检查（n = 79）以及术后 24 小时 pH 监测（n = 21）。 结果在中位随访 5 年中，85 名患者中有 67 名（79%）没有出现反流症状。十八人 (20%) 出现反复症状；四人恢复每日服用抑酸药物。 7 名患者接受了二次修复并且没有任何症状，最终成功率提高到 87%。复发症状在接受 Collis-Belsey (33%) 和腹腔镜 Nissen (26%) 手术的患者中最常见，在经胸 Nissen 手术 (5%) 后最不常见。术后 24 小时 pH 监测结果显示，21 例中有 17 例（81%）正常。在所研究的 79 名患者中，有 17 名检测出复发性食管裂孔疝； 6人无症状。 77%的患者认为自己已痊愈，22%的患者认为病情有所改善，97%的患者表示满意。 16 例中有 7 例 (44%) 低度不典型增生退化为非发育不良 Barrett，63 例中有 9 例 (14%) 肠化生退化为心肌粘膜。 63 名患者中有 4 名 (6%) 出现低度不典型增生。在 410 患者年的随访中，没有患者出现高度不典型增生或癌症。结论在抗反流手术后，大多数 Barrett 患者的反流症状得到持久缓解，几乎所有患者都认为自己已治愈或好转。五分之一的人会出现轻微症状。重要的是，近一半术前存在异型增生的患者消退，14% 患者的肠化生消失，高度异型增生和腺癌全部得到预防。
ObjectiveTo assess the long-term outcome of antireflux surgery in patients with Barrett's esophagus.Summary Background DataThe prevalence of Barrett's esophagus is increasing, and its treatment is problematic. Antireflux surgery has the potential to stop reflux and induce a quiescent mucosa. Its long-term outcome, however, has recently been challenged with reports of poor control of reflux and the inability to prevent progression to cancer.MethodsThe outcome of antireflux surgery was studied in 97 patients with Barrett's esophagus. Follow-up was complete in 88% (85/97) at a median of 5 years. Fifty-nine had long-segment and 26 short-segment Barrett's. Patients with intestinal metaplasia of the cardia were excluded. Fifty patients underwent a laparoscopic procedure, 20 a transthoracic procedure, and 3 abdominal Nissen operations. Nine had a Collis-Belsey procedure and three had other partial wraps. Outcome measures included relief of reflux symptoms (all), patients' perception of the result (all), upper endoscopy and histology (n = 79), and postoperative 24-hour pH monitoring (n = 21).ResultsAt a median follow-up of 5 years, reflux symptoms were absent in 67 of 85 patients (79%). Eighteen (20%) developed recurrent symptoms; four had returned to taking daily acid-suppression medication. Seven patients underwent a secondary repair and were asymptomatic, increasing the eventual successful outcome to 87%. Recurrent symptoms were most common in patients undergoing Collis-Belsey (33%) and laparoscopic Nissen (26%) procedures and least common after a transthoracic Nissen operation (5%). The results of postoperative 24-hour pH monitoring were normal in 17 of 21 (81 %). Recurrent hiatal hernias were detected in 17 of 79 patients studied; 6 were asymptomatic. Seventy-seven percent of the patients considered themselves cured, 22% considered their condition to be improved, and 97% were satisfied. Low-grade dysplasia regressed to nondysplastic Barrett's in 7 of 16 (44%), and intestinal metaplasia regressed to cardiac mucosa in 9 of 63 (14%). Low-grade dysplasia developed in 4 of 63 (6%) patients. No patient developed high-grade dysplasia or cancer in 410 patient-years of follow-up.ConclusionsAfter antireflux surgery, most patients with Barrett's enjoy long-lasting relief of reflux symptoms, and nearly all patients consider themselves cured or improved. Mild symptoms recur in one fifth. Importantly, dysplasia regressed in nearly half of the patients in whom it was present before surgery, intestinal metaplasia disappeared in 14% of patients, and high-grade dysplasia and adenocarcinoma were prevented in all.