腹腔镜疝修补术联合Nissen胃底折叠术治疗食管裂孔疝的前瞻性研究  

Laparoscopic Hernia Repair Combined with Nissen Fundoplication for the Treatment of Esophageal Hiatal Hernia:A Prospective Study

作　　者：丁海涛[1] 韩智君[1] 曹杰[1] 迪米拉[1] 帕尔哈提.阿布都热衣木 DING Hai-tao;HAN Zhi-jun;CAO Jie;DI Mi-la;PAERHATI · Abudureyimu(Department of General Surgery,Sixth Affiliated Hospital,Xinjiang Medical University,Urumqi 830002,Xinjiang,Chin)

机构地区：[1]新疆医科大学第六附属医院普外科,乌鲁木齐830002

出　　处：《中国现代手术学杂志》2018年第2期113-118,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腹腔镜疝修补术联合Nissen胃底折叠术治疗食管裂孔疝的效果。方法选择2016年1月至2017年9月本院收治的157例食管裂孔疝病人作为研究对象,根据随机、前瞻性、对照原则,将157例病人随机分到A组(n=75例)和B组(n=82例),两组病人均予以腹腔镜疝修补术,同时A组加以Nissen胃底折叠术治疗,B组加以Toupet胃底折叠术治疗,对比分析两组病人的手术情况、食管反流情况及食管压力。结果两组患者的手术时间、术中出血量、住院天数、并发症情况及复发情况比较,结果均显示无统计学差异(P>0.05)。手术前,A组、B组患者的24 h内反流次数、反流时间、长反流次数、酸反流时间百分比、食管下括约肌压力、食管残余压、食管松弛率及无效吞咽情况比较,差异无统计学意义(均为P>0.05);手术后6个月,A组、B组患者的24 h内反流次数、反流时间、长反流次数、酸反流时间百分比、食管下括约肌压力、食管残余压、食管松弛率及无效吞咽情况均明显优于手术前,且A组明显优于B组(均为P<0.05)。结论腹腔镜疝修补术联合Nissen胃底折叠术在抗反流效果、抑制术后吞咽困难发生、提高食管下括约肌压力方面的效果均明显优于Toupet胃底折叠术。Objective To investigate the effects of laparoscopic hernia repair combined with Nissen fundoplication for the treatment of esophageal hiatus hernia. Methods A total of 157 patients with esophageal hiatal hernia treated in our hospital from January,2016 to September,2017 were selected as study subjects.According to the random,prospective,and collating principles,157 patients were randomly assigned to group A（ n = 75） and group B（ n = 82）. Laparoscopic hernia repair and gastric fundoplication were performed in both groups. Nissen fundoplication was administered in group A. While Toupet fundoplication was performed in Group B. The operation conditions,esophageal reflux status,and esophageal pressure were compared between the two groups. Results There was no significant difference in operative time,intraoperative blood loss,length of hospital stay,complications,and recurrence between the two groups（ P〈0. 05）. Before surgery,there was no difference in the frequency of 24-hour reflux,reflux time,frequency of long reflux,acid reflux time,lower esophageal sphincter pressure,esophageal residual pressure,esophageal relaxation rate,and ineffective swallowing within 24 hours between group A and B（ P〈0. 05）. 6 months after surgery,the results all were proved to be better than the pre-operative ones,such as the frequency of 24-hour reflux,reflux time,the frequency of long reflux,acid reflux time,and the pressure of the lower esophageal sphincter in group A and B（ P〈0. 05）. Esophageal residual pressure,esophageal relaxation rate and ineffective swallowing were significantly better than the pre-operative ones（ P〈0. 05）,and group A was significantly better than group B（ P〈0. 05）.Conclusions Laparoscopic hernia repair combined with Nissen fundoplication is superior to Toupet fundoplication in preventing anti-reflux effect,inhibiting postoperative dysphagia,and increasing the pressure of the lower esophageal sphincter.

关 键 词：食管裂孔疝 腹腔镜检查 NISSEN胃底折叠术 Toupet胃底折叠术 疝修补术 

分 类 号：R655.4[医药卫生—外科学]