超越症状改善：抗反流手术后患者定义的治疗目标与手术成功的定性研究

文献信息

中文摘要

胃食管反流病（GORD）具有多因素影响，严重损害生活质量。抗反流手术（ARS）是经过适当选择患者的既定治疗方法；然而，当前的结果报告主要关注症状，可能无法充分捕捉影响手术成功感知的患者来源目标和期望。在澳大利亚一家三级上消化道外科单位，对术后患者进行了一项采用半结构化访谈和归纳主题分析的定性研究。探讨了患者识别的GORD体验、对手术的期望以及感知的手术成功决定因素。参与者将GORD描述为一种慢性疾病，对日常功能和社会心理福祉产生普遍影响。手术的主要动机是希望恢复日常功能、减少药物依赖并排除严重病理。手术成功根据以功能改善为中心的多维度、患者定义的目标进行评估。满意度取决于术后结果与术前期望之间的一致性。一些患者可能不追求完全症状缓解，而是接受权衡以优先考虑个体治疗目标。不满意通常与新发的非反流症状相关，尤其是当这些症状导致意外的功能限制时，尽管反流得到有效控制。患者根据术后结果与患者特定、以功能为中心的治疗目标一致的程度来评估满意度。因此，以患者为中心的ARS方法应包括探索患者的手术动机和目标，以指导期望设定和共享决策。将功能结果与常规症状测量相结合，可能进一步改善手术成功的评估。

英文摘要

Gastro-esophageal reflux disease (GORD) has multifactorial effects that substantially impair quality of life. Anti-reflux surgery (ARS) is an established treatment for appropriately selected patients; however, current outcome reporting is largely symptom-focused and may not fully capture patient-derived goals and expectations that shape perceptions of surgical success. A qualitative study using semi-structured interviews and inductive thematic analysis was conducted in postoperative patients at a tertiary upper gastrointestinal surgical unit in Australia. Patient-identified experiences of GORD, expectations of surgery, and perceived determinants of surgical success were explored. Participants described GORD as a chronic condition with pervasive impacts on daily functioning and psychosocial wellbeing. Surgery was primarily motivated by the desire to restore everyday functioning, reduce medication reliance, and exclude serious pathology. Surgical success was evaluated according to multidimensional, patient-defined goals centered on functional improvement. Satisfaction depended on concordance between post-operative outcomes and preoperative expectations. Rather than pursuing complete symptom resolution, some patients may accept trade-offs to prioritize individual treatment goals. Dissatisfaction was commonly associated with new non-reflux symptoms, particularly when these caused unexpected functional limitations, despite effective reflux control. Patients evaluated satisfaction according to the extent to which postoperative outcomes aligned with patient-specific, function-focused treatment goals. A patient-centered approach to ARS should therefore include exploration of patients' motivations for surgery and goals to guide expectation setting and shared decision-making. Incorporating functional outcomes alongside conventional symptom measures may further improve the evaluation of surgical success.