腹腔镜食管裂孔疝修补联合胃底折叠术20例临床分析  

Laparoscopic esophageal hiatal hernia repair and fundoplication: a clinical analysis of 20 cases

作　　者：田峰 杨晓平 曹策[1] 吴建林[1] 祝林[1] 刘志民[1] Tian Feng;Yang Xiaoping;Cao Ce;Wu Jianlin;Zhu Lin;Liu Zhimin(Department of Laparoscopic General Surgery, Zibo Central Hospital, Zibo 255036, Shandong Province, China)

机构地区：[1]淄博市中心医院腹腔镜综合外科,山东255036

出　　处：《中华胃食管反流病电子杂志》2018年第3期121-124,共4页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

摘　　要：目的探讨腹腔镜手术治疗食管裂孔疝的可行性、临床应用价值及安全性。方法选取2012年3月至2017年9月,淄博市中心医院行腹腔镜食管裂孔疝修补联合胃底折叠术20例患者的临床资料,并评价其临床和预后效果。结果 20例患者均顺利完成腹腔镜手术,无中转开腹病例,行Nissen术患者16例、Toupet术4例,20例患者均使用不吸收线修补,7例患者使用U型补片。手术时间95～180 min,平均150 min;术中出血量30～70 ml,平均40 ml;术后24～48 h进流质饮食,术后临床症状均得到有效缓解,无严重并发症及死亡病例,1例胸骨后疼痛患者术后当晚症状消失,3例患者术后3 d出现吞咽困难及进固体食物时轻度哽噎感,经饮食教育2周后症状均得到缓解;4例患者术后1周出现腹泻,给予对症治疗后1周症状缓解;3例患者术后2周反酸症状复发,应用抑酸药物后症状缓解;术后住院时间3～7 d,平均4.1 d;20例患者均得到随访,随访时间3个月至5年,平均2.6年,无死亡病例,无解剖学复发病例,手术结果满意率95.0%。结论腹腔镜微创手术治疗食管裂孔疝,充分体现了创伤小、恢复快、安全可行、疗效可靠的特点,具有推广价值。Objective To explore the feasibility, clinical application value and safety of laparoscopic surgery in treating patients with esophageal hiatal hernia. Methods The clinical data of 20 cases of esophageal hiatal hernia who were enrolled to undertake laparoscopic hiatal hernia repair and fundoplication at our hospital were retrospectively analyzed from March 2012 to September 2017, then we value their clinical results and prognosis. Results All 20 cases of laparoscopic operations were accomplished successfully and no conversions were needed, including 16 cases of Nissen operation, 4 cases of Toupet operation,20 cases of hernia repaired with non-absorbable suture, 7 cases repaired with U Soft Mesh.Mean operation time was 150 minutes (range: 95~180 minutes). Mean intraoperative blood lose was 40ml (range: 30~70 ml).Liquid diets were taken in after 24~48 hours of surgery. Clinical symptoms were effectively relieved in all cases and no mortality and severe complications were noted. Mean postoperative hospital stay were 4.1 days (range: 3~7days). 20 cases were all followed up, and mean follow up period was 2.6 years (range: 3 months to 5 years), there were no cases who dead and with anatomic recurrence, the rate of satisfaction for operation was 95.0%. Conclusion Minimally invasive laparoscopic surgery for esophageal hiatal hernia has the obviously advantages of minimal trauma, fast recovery, safe, high reliability and generalizable value.

关 键 词：食管裂孔疝 腹腔镜 疝修补术 胃底折叠术 临床分析 

分 类 号：R655.4[医药卫生—外科学]