食管裂孔疝患者胃底折叠术后吞咽困难的处理  

Treatment for dysphagia after fundoplication in hiatal hernia patient

作　　者：周太成[1] 于洪燕[1] 马宁[1] 宗振[1] 陈嘉林 余卓敏 江志鹏[1] 李英儒[1] 候泽辉 甘文昌[1] 汤福鑫 陈双[1] Zhou Taicheng;Yu Hongyan;Ma Ning;Zong Zhen;Chen Jialin;Yu Zhuomin;Jiang Zhipeng;Li Yingru;Hou Zehui;Gan Wenchang;Tang Fuxin;Chen Shuang(Department of Gastroenterogy and Hernia, 6th Affliated Hospital of Sun Yat-Sen University, Guangzhou 510655, China)

机构地区：[1]中山大学附属第六医院胃肠、疝和腹壁外科

出　　处：《中华胃食管反流病电子杂志》2019年第2期61-65,共5页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

基　　金：广东省科技计划项目(2017A020215036);广州市科技计划项目(201806020036)

摘　　要：目的探讨食管裂孔疝患者胃底折叠术后出现吞咽困难的原因及临床处理方法。方法回顾性分析2014年1月至2019年1月,中山大学附属第六医院食管裂孔疝修补+胃底折叠术后,出现吞咽困难21例患者的临床资料。分析吞咽困难出现的原因、时间、处理方式及效果。结果 21例患者中,根据Saeed评分:0分0例、1分2例、2分3例、3分5例、4分11例;出现时间:术后1周内5例、1~2周10例、>2周6例;折叠方式:Nissen折叠15例、Toupet折叠4例、DOR折叠2例;处理方式:药物治疗14例、胃镜下球囊扩张6例、再次手术改折叠1例;所有患者吞咽困难症状均缓解。结论吞咽困难是胃底折叠术后常见并发症,大部分为轻度、经保守治疗可缓解,一部分中重度吞咽困难需要通过胃镜下扩张,且胃镜下球囊扩张效果明显,球囊扩张失败患者需要再次采取手术改折叠方式。Objective To investigate the causes and clinical treatment of dysphagia after fundoplication of hiatal hernia patients. Methods Clinical data of 21 patients with dysphagia after esophageal hiatus hernia repair and fundoplication in our hospital were retrospectively analyzed. The causes,occurring time, treatment methods and effect of dysphagia were analyzed. Results Of all 21 patients,according to Saeed dysphagia score, there were 0 case of 0 point, 2 cases of 1 point, 3 cases of 2 points, 5 cases of 3 points, 11 cases of 4 points;occurrence time: 5 cases within one week after operation, 10 cases within one to two weeks, 6 cases within two weeks postfundoplication;Fundoplication methods 15 cases treated with Nissen fundoplication, 4 cases with Toupet fundoplication, 2 cases treated with Dor fundoplication;Treatment: 14 Cases treated with medicine management and 6 cases with balloon dilation via endoscopy, another case failed with dilation accepted with re-operation which change fundoplication method;all patients with dysphagia were relieved. Conclusion Dysphagia is one of most common complications after fundoplication in hiatal hernia patients, most of which is mild, conservative treatment can be alleviated.Moderate to severe dysphagia patients need to be dilated under endoscopy, and the effect of balloon dilation is always good, few case need re-operation.

关 键 词：疝 食管裂孔 胃底折叠术 吞咽困难 球囊扩张 

分 类 号：R655.4[医药卫生—外科学]