腹腔镜Ⅴ型胃底折叠术治疗食管裂孔疝合并胃食管反流病  

Laparoscopic V fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease

作　　者：于涛[1] 于磊[1] 张葆勋[1] 李飞[1] 余震[1] 杨兴国[1] Yu Tao;Yu Lei;Zhang Baoxun;Li Fei;Yu Zhen;Yang Xingguo(Department of Thoracic Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院胸外科,100730

出　　处：《中国医师杂志》2020年第6期857-860,865,共5页Journal of Chinese Physician

基　　金：北京市医管局临床医学发展专项(扬帆计划)重点医学专业发展计划项目"微创消化外科"(ZYLX201612);北京市卫生系统高层次卫生技术人才培养计划(2014-3-014)。

摘　　要：目的:探讨Ⅴ型胃底折叠术在治疗食管裂孔疝合并胃食管反流病中的效果和价值。方法:回顾性分析2012年1月至2018年11月期间,北京同仁医院行腹腔镜胃底折叠术治疗食管裂孔疝合并胃食管反流病患者115例的病例资料,其中行Nessin术68例,Ⅴ型胃底折叠术47例,记录2组患者手术情况、术后恢复情况、术后并发症、术后胃食管反流病问卷(GERD-Q)评分等,并进行比较。结果:Ⅴ型胃底折叠术与Nissen术式相比,手术时间缩短,但差异无统计学意义(P>0.05);二者围手术期的术中出血量、术后饮水时间、引流管拔出时间、术后住院时间等指标差异无统计学意义(P>0.05);二者术后患者反流症状改善、食管测压、24 h食管pH监测结果差异无统计学意义(P>0.05),且均无复发;Ⅴ型胃底折叠术术后吞咽困难的发生率明显低于Nissen术式,差异有统计学意义(P<0.05);二者腹胀、腹泻、便秘等并发症发生率上二者差异无统计学意义(P>0.05)。结论:腹腔镜Ⅴ型胃底折叠术作为抗反流术式,具有操作简单、效果明确、并发症少、易于规范化推广的优势。Objective To investigate the effect and value of V-type fundoplication in the treatment of hiatal hernia with gastroesophageal reflux disease.Methods From January 2012 to November 2018,a retrospective analysis was performed on 115 cases of patients with esophageal hiatal hernia and gastroesophageal reflux disease who underwent laparoscopic fundoplication in our hospital,including 68 cases of Nissen operation and 47 cases of type V-type stomach fundoplication.The information of surgical status,postoperative recovery,postoperative gastroesophageal reflux disease questionnaire(GERD-Q)score,and postoperative complications were collected and analyzed in these 2 groups.Results Compared with Nissen technique,the operation time of V-shaped fundus plication was shortened,but the difference was not statistically significant(P>0.05).There was no statistical difference in terms of indicators including intraoperative blood loss,postoperative drinking time,drainage tube extraction time,postoperative hospitalization time between two types of the operation(P>0.05);the difference between the two groups was not statistically significant in the improvement of reflux symptoms,manometry and 24-hour pH result among the postoperative patients(P>0.05);all the patients had no recurrence occurred;the incidence of dysphagia after surgery was significantly lower in V-shaped gastric fundus compared with Nissen operation,with statistically significant difference(P<0.05);there was no statistical difference in the incidence of bloating,diarrhea,and constipation(P>0.05).Conclusions Laparoscopic V-shaped fundus fold surgery,as an anti-reflux technique,has the advantages of simple operation,clear results,fewer complications and easy standardization.

关 键 词：疝 食管裂孔 胃食管反流 胃底折叠术 腹腔镜检查 

分 类 号：R655.4[医药卫生—外科学]