Bougie管支撑下腹腔镜Nissen胃底折叠术治疗食管裂孔疝合并胃食管反流临床效果分析  

Clinical effect analysis of laparoscopic Nissen fundoplication under Bougie tube supporting for hiatal hernia combined with gastroesophageal reflux

作　　者：刘山 佟思羽 刘国栋 王士平 曹关义 LIU Shan;TONG Siyu;LIU Guodong;WANG Shiping;CAO Guanyi(Deparment of Gastrointestinal Surgery,Suqian First People's Hospital,Suqian 223800,Jiangsu,China;Department of Health Management Center,Suqian First People's Hospital,Suqian 223800,Jiangsu,China)

机构地区：[1]宿迁市第一人民医院胃肠外科,江苏宿迁223800 [2]宿迁市第一人民医院健康管理中心,江苏宿迁223800

出　　处：《中国现代手术学杂志》2023年第4期269-274,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨Bougie管支撑下行腹腔镜Nissen胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床效果。方法回顾性分析2017年10月至2021年10月我科手术治疗的70例食管裂孔疝合并胃食管反流患者的临床资料,按手术方式分为两组,分别行腹腔镜食管裂孔疝修补+Nissen胃底折叠术(Nissen组,35例)和腹腔镜食管裂孔疝修补+Bougie管支撑下胃底Nissen折叠术(Bougie组,35例)。比较两组患者围术期指标、术后1月内并发症发生率及术后半年胃食管反流指标。结果Bougie组手术时间、术后恢复饮水时间、术后恢复半流质饮食时间及术后住院时间均少于Nissen组,术后第1、2、3周胸腹部疼痛、腹胀不适发生率及术后1、2、3、4周吞咽困难发生率均低于Nissen组,差异均有统计学意义(P<0.05),而两组术中出血量、术后拔除引流管时间、术后首次排气时间、术后1月内便秘与腹泻发生率比较均无统计学差异(P>0.05)。术后6月两组患者食管pH值<4的次数、反流次数、反流时间、食管下段括约肌压力、DeMeester评分、GERD-Q评分均较术前明显改善(P<0.05),而组间上述各项反流指标比较均无统计学差异(P>0.05)。结论Bougie管支撑下行腹腔镜Nissen胃底折叠术治疗食管裂孔疝合并胃食管反流病,可明显减少术后早期并发症的发生,抗反流效果确切,且并不增加手术难度及手术风险,值得临床推广。Objective To investigate the clinical effect of laparoscopic Nissen fundoplication under Bougie tube supporting in the treatment of hiatal hernia(HH)combined with gastroesophageal reflux disease(GERD).Methods The clinical data of 70 patients with HH combined with GERD admitted from October 2017 to October 2021 were analyzed retrospectively,including 35 cases performed Nissen fundoplication operation(as Nissen group)and 35 cases received Nissen fundoplication under Bougie tube supporting(Bougie group).The perioperative indexes,the incidence of complications within one month after the operation and the reflux indicators half a year after the operation were compared between the two groups.Results Compared to Nissen group,the operation time,recovery time of taking water and half-fluid diet time and hospital stays were shorter,incidence of chest and abdominal pain and abdominal distention of 1st,2nd and 3rd week after the surgery and dysphagia of 1st,2nd,3rd and 4th week after the surgery were lower in the Bougie group,and all the differences were significant statistically(P<0.05).While there were no statistical differences in intra-operative blood loss,post-operative removal time of drainage tube,exhaust recovery time and incidence of constipation and diarrhea within one month after the surgery between the two groups(P>0.05).The times of esophageal pH value<4,reflux frequency,reflux time,lower esophageal sphincter pressure,DeMeester score and GERD-Q score of both groups were improved significantly 6 months after the operation(P<0.05),but there was no significant difference in the reflux indexes mentioned above between the two groups(P>0.05).Conclusion Laparoscopic Nissen fundoplication under Bougie tube supporting can reduce the early post-operative complications significantly,achieve exact anti-reflux effect and not increase the difficulty and risk of the operation for HH combined with GERD,and which is worthy of clinical promotion.

关 键 词：食管裂孔疝 胃食管反流病 Bougie管 NISSEN胃底折叠术 

分 类 号：R655.4[医药卫生—外科学]