腹腔镜再手术治疗小儿复发性食管裂孔疝  

Laparoscopic re-operation for children with recurrent hiatus hernia

作　　者：施佳[1] 王俊[1] 严文波[1] 潘伟华[1] 邬文杰[1] 吴晔明[1] 

机构地区：[1]上海交通大学医学院附属新华医院儿外科,上海市200092

出　　处：《临床小儿外科杂志》2016年第4期346-347,353,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的：探讨腹腔镜再手术治疗小儿复发性食管裂孔疝的疗效及预后。方法自2010年至2014年我们对6例复发性食管裂孔疝患儿实施腹腔镜下食管裂孔疝再修补、胃底折叠术。患儿年龄3个月至17月，平均9．6个月。术后复发时间3～9个月，平均6．2个月。术后复查食管钡餐造影（GI）和24 h 食管 PH 值监测进行评估。结果本组病例中，5例首次手术经腹腔镜完成，1例经右侧胸腔完成。6例均顺利完成腹腔镜再手术，无中转开腹手术。2例修补膈肌脚的缝线脱落，2例一侧膈肌脚被缝线切割裂开，2例膈肌脚缝合不紧密，均通过缝线再次缝合，未使用人工补片。手术时间2～3 h。术中出血25 mL，无一例食管穿孔。随访1～4年，术后无呕吐、呛咳、肺炎等症状，吞咽功能良好，复查 GI 无复发，24 h 食管 pH 值监测无病理性反流。结论小儿食管裂孔疝经腹腔镜或经胸修补后复发者，通过腹腔镜再次修补是切实可行的方法。Objetive To explore the efficacy and prognosis of laparoscopic re-operation for recurrent hi-atus hernia in children. Methods From 2010 to 2014,6 children with recurrent hiatus hernia underwent lap-aroscopic re-operation of hiatus hernia repair and fundoplication.Their average age was 9.6 （3 ~17）months. And the average time of postoperative recurrence was 6.2 （3 ~9）months.Postoperative esophageal barium meal radiography （GI）and 24 h esophageal pH monitoring were evaluated. Results Five cases underwent laparoscopy for the first time and 1 case was operated via right pleura.All cases were successfully re-operated laparoscopically.There was no conversion.Diaphragmatic foot was sutured off （n =2）,one side of diaphrag-matic foot was sliced by suture （n =2）and diaphragmatic foot was sutured loosely （n =2）.All cases were re-sutured without using artificial patch.Operative duration was 2 ~3 hours.The volume of intraoperative hemor-rhage was 2 ~5 mL.There was no esophageal perforation.During a postoperative follow-up period of 1 ~4 years,there was no onset of such symptoms as vomiting,choking cough and pneumonia.Swallowing function was excellent.GI showed no recurrence and 24 h esophageal pH monitoring showed no pathological re-flux. Conclusions Laparoscopic re-operation is feasible for recurrent hiatus hernia after laparoscopic or open chest operation.

关 键 词：疝 食管裂孔 腹腔镜 再手术 儿童 

分 类 号：R726.5[医药卫生—儿科]