Laparoscopic antireflux surgery in the lung transplant population
Laparoscopic antireflux surgery in the lung transplant population
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DOI：
10.1007/s00464-001-8251-2
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发表时间：
2002-12-01
影响因子：
3.1
通讯作者：
Eubanks, S
中科院分区：
文献类型：
--
作者：
Lau, CL;Palmer, SM;Eubanks, S
背景：肺移植已成为多种终末期肺部疾病患者的可行治疗选择。随着移植后手术效果的改善，肺移植的最大限制仍然是慢性同种异体移植功能障碍。胃食管反流病（GERD）引起的误吸被认为是同种异体移植功能障碍的潜在因素。 GERD常见于终末期肺病患者，在移植后的患者中更为常见。我们在此报告腹腔镜胃底折叠术治疗肺移植患者 GERD 的安全性。方法：杜克大学医学中心进行的 298 例肺移植手术中，有 18 例因严重 GERD 接受了抗反流手术。评估了腹腔镜胃底折叠术在该人群中的安全性和益处。结果：抗反流手术包括 13 例腹腔镜 Nissen 胃底折叠术、4 例腹腔镜 Toupets 和 1 例开放式 Nissen（继发于广泛粘连）。 18 名患者中有两名报告症状复发 (11%)，另外两名报告术后出现轻微胃肠道症状（恶心、腹胀）。抗反流手术没有造成死亡。胃底折叠术后，18 名患者中有 12 名显示出肺功能明显改善（67%）。结论：GERD 常见于移植后肺人群。当有需要时，腹腔镜胃底折叠手术可以安全地进行，并且发病率和死亡率最低。除了反流症状得到缓解外，胃底折叠术后该人群的肺功能也可能得到改善。患有严重胃食管反流病的肺移植患者应强烈考虑进行抗反流手术。
Background: Lung transplantation has emerged as a viable therapeutic option for patients with a variety of end-stage pulmonary diseases. As immediate posttransplant surgical outcomes have improved, the greatest limitation of lung transplantation remains chronic allograft dysfunction. Gastroesophageal reflux disease (GERD) with resultant aspiration has been implicated as a potential contributing factor in allograft dysfunction. GERD is prevalent in end-stage lung disease patients, and it is even more common in patients after transplantation. We report here on the safety of laparoscopic fundoplication surgery for the treatment of GERD in lung transplant patients.Methods: Eighteen of the 298 lung transplants performed at Duke University Medical Center underwent antireflux surgery for documented severe GERD. The safety and benefit of laparoscopic fundoplications in this population was evaluated.Results: The antireflux surgeries included 13 laparoscopic Nissen fundoplications, four laparoscopic Toupets, and one open Nissen (converted secondary to extensive adhesions). Two of the 18 patients reported recurrence of symptoms (11%), and two others reported minor GI complaints postoperatively (nausea, bloating). There were no deaths from the antireflux surgery. After fundoplication surgery, 12 of the 18 patients showed measured improvement in pulmonary function (67%).Conclusions: GERD occurs commonly in the posttransplant lung population. Laparoscopic fundoplication surgery, when indicated, can be done safely with minimal morbidity and mortality. In addition to the resolution of reflux symptoms, improvement in pulmonary function may be seen in this population after fundoplication. Lung transplant patients with severe GERD should be strongly considered for antireflux surgery.