Clin Gastroenterology H: 行抗胃食管反流手术后吞咽困难患者的临床特征及预后

2019-09-05 不详 MedSci原创

吞咽困难是抗胃食管反流手术(ARS)治疗胃食管反流病(GERD)的一种远期并发症。本项研究旨在探究这类患者的临床特征及预后。

背景与目的
吞咽困难是抗食管反流手术(ARS)治疗食管反流病(GERD)的一种远期并发症。本项研究旨在探究这类患者的临床特征及预后。

方法
研究人员对2003年到2014年间接受ARS手术的157名GERD患者(平均年龄65.1±1.0岁; 72%女性)进行了一项回顾性研究。使用自我报告的李克特量表对失血性后吞咽困难进行了临床特征评估,其中0分代表无吞咽困难,4分代表严重的每日吞咽困难; 得分为2或更高表明临床上有着显着的吞咽困难。术后吞咽困难分类为早期(ARS后≤6周)或晚期(ARS后> 6周),Kaplan-Meier分析用于评估临床显着吞咽困难的发展时间。我们进行了单变量和多变量分析,以评估管理反应并确定与吞咽困难相关的因素。

结果
在157例患者中,54.8%的患者有术后吞咽困难(有临床表现的占20.4%); 只有3.5%需要内镜介入治疗,29例患者(18.5%)发生术后晚期吞咽困难。根据Kaplan-Meier分析,有临床表现的吞咽困难的中位时间为0.75年(95%CI,0.26-1.22)。在接受内镜扩张的13名患者(44.8%)中,根据李克特量表,改善率为92.3%,早期吞咽困难,复发性食管裂孔疝和多次快速吞咽后收缩储备不足是ARS术后晚期吞咽困难的单变量预测因子(P≤.04); 基于多变量逻辑回归分析,收缩后储备的缺乏与晚期吞咽困难独立相关(优势比,3.73; 95%CI,1.11-12.56)。

结论
本项研究表明多次快速吞咽收缩储备缺乏与ARS术后晚期吞咽困难独立相关。可以保守治疗或通过内窥镜扩张成功解决早期和晚期的术后吞咽困难。

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    2019-12-18 许安
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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1437461, encodeId=4666143e46191, content=<a href='/topic/show?id=0e311010591a' target=_blank style='color:#2F92EE;'>#食管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101059, encryptionId=0e311010591a, topicName=食管)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Sat Sep 07 01:20:00 CST 2019, time=2019-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1504766, encodeId=e6631504e665a, content=<a href='/topic/show?id=7730e85412' target=_blank style='color:#2F92EE;'>#Gastroenterology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, 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  8. 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    2019-09-07 zhouqu_8
  9. 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  10. 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    2019-09-07 feifers

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