腹腔镜下Rosetti’s和Thal’s胃底折叠术治疗婴幼儿胃食管反流  

Laparoscopic rosetti and thal fundoplication in children with gastroesophageal reflux disease

作　　者：吴晔明[1] 严志龙[1] 洪莉[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心,上海第二医科大学儿童微创外科中心,200217

出　　处：《中华小儿外科杂志》2005年第6期308-310,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的结合病例和文献介绍腹腔镜辅助下不同术式胃底折叠抗反流手术治疗儿童严重胃食管反流性疾病。方法腹腔镜下应用Rosetti’s、Thal’s胃底折叠术治疗胃食管反流性疾病8例,男6例,女2例。年龄2个月～2岁,平均4.6个月。6例为食管裂孔疝,2例为严重胃食管反流。结果8例中1例因早期经验不足未能完成手术中转开腹。7例在腹腔镜下完成胃底折叠术。其中,3例行Rosetti’s术,4例行Thal’s术。手术经过顺利,术中出血少,所有病例术中均无需输血,手术后24h开始进食,术后第5～7d出院,出院前均作钡剂胃食管造影,6例未见明显反流。术后随访3个月～2年,所有患儿生长发育好,无明显胃食管反流临床症状,二种术式临床效果无明显区别。结论腹腔镜下Rosetti’s和Thal’s胃底折叠术治疗儿童胃食管反流性疾病可获得较好的临床效果,镜下操作简单、风险小。Objective To introduce laparoscopic (LP) antireflux procedure for severe gastroeasophageal reflux disease (GERD) in children. Methods Between October 2000 and April 2004, eight children with GERD underwent LP Rosetti`s or Thal`s fundoplication procedures in Shanghai Children`s Medical Center. There were 6 boys and 2 girls. The age varied from 2 months to 2 years old (mean (4.6) months). Weight ranged from (2.9) kg to 12kg. Six of 8 children also had hiatus hernia. Results LP fundoplication procedure was completed in 7 children. There was one conversion. There were 3 Rosetti`s and 4 Thal`s procedures. There was minimal blood loss. Seven children started to feed 24 hours post-operatively. The duration of post-operative hospitalization was 5~7 days. Further test showed that one patient had mild recurrence of gastroeasophageal reflux. All children thrived and were asymptomatic of GERD in the follow- up period (3 months to 2 years). The clinical results showed no obviously difference between the Rosetti and Thal procedures. Conclusions LP Rosetti's and Thal`s fundoplications for children with GERD are effective.

关 键 词：胃底折叠术 腹腔镜下 胃食管反流性疾病 婴幼儿 临床效果 腹腔镜辅助 食管裂孔疝 手术治疗 中转开腹 早期经验 手术经过 术中出血 食管造影 术后随访 生长发育 临床症状 抗反流 24h 手术后 出院前 严重 儿童 术式 病例 

分 类 号：R726.5[医药卫生—儿科]