腹腔镜下应用复合补片治疗老年食管裂孔疝35例临床疗效观察  

Laparoscopic hiatal hernia repair with composite mesh used in elderly patients:a clinical review of 35 cases

作　　者：郑伟[1] 张辉[1] 张超[1] Zheng Wei;Zhang Hui;Zhang Chao(Department of Henan Provincial People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,郑州450003

出　　处：《中华胃食管反流病电子杂志》2019年第4期188-191,共4页Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)

摘　　要：目的探讨腹腔镜下应用防粘连复合补片在老年食管裂孔疝修补中的临床价值(60岁以上老人)。方法回顾分析河南省人民医院胃肠疝外科2015年6月至2018年6月收治的35例老年食管裂孔疝患者,应用防粘连复合补片完成腔镜食管裂孔疝修补加胃底折叠手术患者的临床资料,其中8例患者行360°Nissen胃底折叠,12例行270°Toupet胃底折叠,15例行前180°Dor胃底折叠。结果 35例患者均应用防粘连复合补片完成腹腔镜下食管裂孔疝修补治疗,无中转开腹。症状完全消失28例,好转7例。5名患者术后出现不同程度的吞咽困难(Nissen组4名患者,Toupet组1名患者),1名患者出现腹胀(Dor组)。随访6~42个月,所有患者均无复发。结论应用防粘连复合补片对于老年患者行腹腔镜食管裂孔疝修补手术治疗安全可靠,选择270°Toupet,前180°Dor胃底折叠显得更为适合老年患者。Objective To investigate the clinical value and safety of composite mesh used in laparoscopic hiatal hernia repair in elderly patients(above 60 years of age).Methods We retrospectively reviewed 35 elderly patients with esophageal hiatal hernia undergone laparoscopic hernia repair surgeries in Henan Provincial People's Hospital between June 2015 and June 2018.Those surgeries were completed using composite patches:8 cases of Nissen 360-degree fundoplication,12 cases of Toupet 270-degree fundoplication,and 15 cases of Dor anterior 180-degree partial fundoplication.Results All 35 cases of esophageal hiatal hernia repair using composite mesh were completed laparoscopically,intraoperative change to open surgery was not required.The symptoms disappeared completely in 28 cases and improved in 7 cases.5 patients experienced various degrees of dysphagia(4 patients in the Nissen group,1 patient in the Toupet group).1 patient suffered abdominal distension(Dor group).All patients were followed up for 6~42 months,no recurrence occurred.Conclusions It is safe and reliable to use composite mesh for laparoscopic hiatal hernia repair surgeries in elderly patients.Toupet and Dor fundoplication has shown more advantages for elderly patients with less complication.

关 键 词：腹腔镜、食管裂孔疝 复合补片 疝修补 老年患者 

分 类 号：R655.4[医药卫生—外科学]