腹腔镜食管裂孔疝修补术治疗食管裂孔疝129例  

Laparoscopic repair of esophageal hiatal hernia:an analysis of 129 cases

作　　者：王帅[1] 秦鸣放[1] 

机构地区：[1]天津市南开医院微创外科,天津市南开区300100

出　　处：《世界华人消化杂志》2011年第34期3503-3507,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨两种腹腔镜食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝疾病的有效性.方法:回顾性分析了天津市微创外科中心于2001-03/2009-02采用腹腔镜技术治疗的129例食管裂孔疝患者资料.按照术式的不同分成2组:Nissen组53例,采用Nissen全360°胃底折叠术;Dor组76例,采用Dor前180°胃底折叠术.结果:手术顺利,无死亡病例.30例患者(N组16例,D组14例)术后早期出现吞咽不适,21例4mo内自行缓解.3例(Nissen组)持续吞咽困难患者半年后行内镜下食管扩张治疗.6例疝复发(Nissen组1例,Dor组5例).手术总体满意率89.15%.结论:腹腔镜食管裂孔疝修补和胃底折叠术能够有效的治疗食管裂孔疝疾病.Dor前180°胃底折叠术能够降低Nissen全360°胃底折叠术由于折叠过紧、迷走神经分支损伤带来的腹胀、吞咽不畅等相关并发症的发生率,但是抗反流效果仍较后者为弱.AIM： To evaluate the clinical effects of two different laparoscopic procedures in the management of esophageal hiatal hernia. METHODS： The clinical data for 129 patients who underwent laparoscopic surgery for esophageal hiatal hernia from March 2001 to February 2009 at our hospital were retrospectively analyzed. All patients were divided into two groups based on the laparoscopic procedure used： Nissen group （360° fundoplication, n = 53） or Dor group （anterior 180° fundoplication, n = 76）. RESULTS： All operations were performed smoothly. No death occurred. Thirty patients （16 in the Nissen group and 14 in the Dor group） de- veloped dysphagia after surgery, and 21 of them relieved within four months. Three patients in the Nissen group received esophageal dilatation for persistent dysphagia. Six months later, six patients had recurrence. The satisfaction rate was 89.51%. CONCLUSION： Laparoscopic repair of esopha-geal hiatal hernia is an effective way to treat hiatal hernia. Dor anterior 180° fundoplication can decrease the incidence of postoperative dysphagia, abdominal distension and other complications, which might be caused by the Nissen procedure because of tighter fundoplication and injuries of the branches of vagus.

关 键 词：腹腔镜 食管裂孔疝 Dor胃底折叠术 NISSEN胃底折叠术 

分 类 号：R656.2[医药卫生—外科学]