腹腔镜下Nissen术式治疗胃食管反流病手术技巧浅析  

Operative techniques of Laparoscopic Nissen fundoplication for gastroesophageal reflux disease

作　　者：徐雪东[1] 安伟德[1] 周抒[2] 

机构地区：[1]大连医科大学附属第一医院3部普外科,辽宁省116000 [2]大连医科大学附属第一医院3部妇产科,辽宁省116000

出　　处：《中华胃食管反流病电子杂志》2015年第2期81-85,共5页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

基　　金：国家自然科学基金青年科学基金(30900747)

摘　　要：目的：探讨腹腔镜下Nissen术式的手术技巧,提高手术安全性及术后疗效。方法回顾性分析2014年9月至2015年1月在美国佛罗里达医院奥兰多分部进行腹腔镜下Nissen术式的42例胃食管反流病合并食管裂孔疝患者临床资料,统计患者手术时间、术中出血量、术后住院时间、术后胃肠道功能恢复时间、术后并发症发生情况。结果42例患者手术时间平均59（48~88）min；术中出血量平均12（5~30）ml,无术中术后输血者。术后24~48 h全流质饮食,术后住院1~3 d。42例患者术后随访2~5个月,2例术后出现吞咽困难,1例经保守治疗缓解,1例因过紧再次手术后缓解。因随访时间短尚未有食管裂孔疝复发,1例患者症状活动时出现刀口疼痛,2例患者反流症状缓解后又出现复发,经口服抑酸药物后症状缓解。结论腹腔镜下Nissen术式中的相关手术技巧,可显著提高手术安全性,缩短手术时间。Objective To summarize operative techniques of laparoscopic Nissen fundoplication for GERD. Methods From September 2014 to January 2015,42 cases of GERD patients underwent laparoscopic Nissen fundoplication. Statistics were collected about operation time, intraoperative blood loss, postoperative hospital stay and recovery of gastrointestinal tract function. Results The mean operation time was 59（48 to 88）minutes,and intraoperative blood loss was 12（5 to 30）ml without transfusion. 24 to 48hr after operation, full liquid food was supplied to patients. The postoperative hospital stay was 1 to 3 days. Follow-up time was from 2 to 5 months. Dysphagia appeared in 2 cases,one was relieved by medical treatment and the other was relieved by operation once more. There was no recurrence because of short follow-up. One patient complained a pain in incision when moving. There were reflux symptoms in 2 patients after a temple relief, whose symptoms were relived by oral anti acid drugs. Conclusion Using some operative techniques will provide much more security of operations and shorten the operation time.

关 键 词：胃食管反流 胃底折叠术 腹腔镜检查 

分 类 号：R656.6[医药卫生—外科学]