腹腔镜疝修补术治疗巨大食管裂孔疝96例临床分析  

Laparoscopic repair of giant hiatal hernia:A clinical analysis of 96 patients

作　　者：陈震[1] 赵宏志[1] 王震宇[1] 吴瑜[1] 

机构地区：[1]天津市南开医院天津市微创外科中心,天津300100

出　　处：《中国实用外科杂志》2017年第11期1265-1268,共4页Chinese Journal of Practical Surgery

摘　　要：目的评价腹腔镜疝修补术治疗巨大食管裂孔的效果及安全性。方法回顾性分析2006年1月至2016年7月天津市南开医院采用腹腔镜疝修补手术治疗的96例巨大食管裂孔疝病人资料,其中33例未使用补片,63例使用补片修补,84例同时行不同类型的胃底折叠术。结果 96例均完成腹腔镜手术,无中转开放病例。非补片组和补片组的手术时间分别为(95.8±13.1)min和(101.4±15.6)min(P=0.0814),术中出血量分别为(77.5±21.3)m L和(79.6±24.5)m L(P=0.6769),术后住院时间分别为(5.4±4.3)d和(5.5±3.7)d(P=0.9151),近期术后并发症发生率分别为6.1%(2/33)和9.5%(6/63)(P=0.71),差异均无统计学意义。85例获得长期随访(非补片组28例,补片组57例),随访率为88.5%(85/96),随访时间为56.3个月(6个月至10年)。16例症状复发或出现新的症状,非补片组和补片组的反酸复发率分别为17.9%(5/28)和3.5%(2/57)(P=0.0364),吞咽困难发生率分别为0(0/28)和15.8%(9/57)(P=0.0269),差异有统计学意义。手术结果满意率分别为85.7%(24/28)和82.5%(47/57),差异无统计学意义(P=1)。63例使用补片病人中,29例为"O"形补片,34例为"U"形补片,两组近期并发症发生率为10.3%(3/29)和8.8%(3/34)(P=1),两组分别有25例和32例获得长期随访,随访时间分别为97(71~120)个月和29(6~68)个月。反酸复发率分别为4.0%(1/25)和3.1%(1/32)(P=1),吞咽困难发生率分别为24.0%(6/25)和9.4%(3/32)(P=0.1606),差异均无统计学意义。6例经胃镜证实的食管狭窄中4例为O形补片,2例为U形补片,差异无统计学意义(P=0.3883)。结论腹腔镜疝修补术治疗巨大食管裂孔疝具有安全性高、疗效可靠的特点。应用补片能减少裂孔疝复发,但存在并发远期吞咽困难、补片移位的风险。把握补片使用指征、选择适宜补片、优化补片放置方式可降低相关并发症发生率;恰当的选择胃底折叠术式、正确处理短食管可提高手术疗效。Objective To estimate the effectiveness and safety of lapB^oscopic repair of giant hiatal hernia. Methods The clinical data of 96 patients with giant hiatal hernia performed laparoscopie repair between January 2006 and July 2016 in Department of Mini-invasive Surgery,Tianjin Nankai Hospital were analyzed retrospectively. Primary hiatal closure was performed in 33 patients, and the hiatus was reinforced with mesh strips in 63 patients. A total or partial fundoplication was added in 84 patients. Results All the 96 patients were treated by laparoscopy successfully. No conversion occurred. The mean operative time was （95.8± 13.1 ）min for primary hiatal closure patients and （101.4± 15.6） for mesh repair patients （P=0.0814）. The average operative blood loss was （77.5±21.3）mL for primary hiatal closure patients and （79.6 ± 24.5 ） mL for mesh repair patients （P=0.6769）. The mean postoperative hospital stay was （5.4±4.3 ） d for primary hiatal closure patients and （5.5±3.7 ） d for mesh repair patients （P=0.9151）. Early postoperative complications occurred in 6.1% （ 2/33 ） for primary hiatal closure patients and 9.5 % （ 6/63 ）for mesh repair patients （P=0.71）. Eighty-five of the 96 patients （88.5%） were available for following-up,among which there were 28 patients in primary hiatal closure group and 57 in the mash repair group, and the mean follow-up time was 56.3 months（range 6-120 months）. Altogether,recurrence symptoms and developed new symptoms were demonstrated in 16 patients. Sour regurgitation recurrence occurred in 17.9% （5/28） of primary hiatal closure patients and 3.5% （2/57）of mesh repair patients （P=0.0364）, dysphagia occurred in 0 （0/28） of primary hiatal closure patients and 15.8 % （9/57 ） of mesh repair patients （P=0.0269）. 85.7% （24/28） of primary hiatal closure patients and 82.5% （47/57） of mesh repair patients satisfied with the outcome of operation （P=1）. Among 63 mesh repair patients,＂O＂shape mesh was pe

关 键 词：食管裂孔疝 腹腔镜 疝修补术 胃底折叠术 补片 

分 类 号：R6[医药卫生—外科学]