食管裂孔疝合并胃扭转的腹腔镜手术治疗  

Laparoscopic surgery for hiatal hernia with gastric volvulus

作　　者：关磊 聂玉胜[1] 杨慧琪 Guan Lei;Nie Yusheng;Yang Huiqi(Department of Hernia and Abdominal Wall Surgery,Beijing Chao-Yang Hospital,Capital Medical University,Bejing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院疝和腹壁外科,北京100043

出　　处：《中华普通外科杂志》2024年第6期430-434,共5页Chinese Journal of General Surgery

基　　金：北京市卫生健康委员会首都卫生发展科研专项(自主创新)资助(首发2020-2-2035)。

摘　　要：目的探讨腹腔镜治疗食管裂孔疝合并胃扭转的可行性及安全性.方法回顾性分析2021年6月至2022年12月首都医科大学附属北京朝阳医院收治的29例食管裂孔疝合并胃扭转患者的临床资料,术前均诊断明确,其中26例为食管裂孔疝合并慢性胃扭转患者,3例合并急性胃扭转经有效保守治疗后手术,以上均择期行腹腔镜下食管裂孔疝修补术,术中均放置补片,根据食管动力情况行胃底折叠术,对患者的术前基本情况、手术时间、术中出血量、胃疝出比例、疝分型、胃扭转分类、中转开腹情况、术后住院时间、术后并发症、症状改善率及术后满意度进行分析.结果29例患者最常见的主诉为慢性梗阻症状,均在腹腔镜下顺利完成手术,无中转开腹病例,其中Ⅲ型疝最常见为19例(65%),器官轴性胃扭转最常见为20例(70%).平均手术时间(110.2±33.3)min,平均术中出血量(12.6±7.0)ml,平均胃疝出比例75.9%±15.8%,平均疝环缺损长度(6.6±1.2)cm,平均疝环缺损宽度(5.0±1.1)cm.术后平均住院时间(6.4±1.7)d,围手术期发生肺部感染2例(7%),肺不张2例(7%),胃动力障碍1例(3%).术后均治愈出院,随访15~32个月,未发生补片感染、长期慢性疼痛、肠梗阻、疝复发等严重并发症,术后症状改善率90%,术后满意度90%.结论腹腔镜手术治疗食管裂孔疝合并胃扭转安全、可行,疗效可靠.Objective To evaluate the feasibility and safety of laparoscopic surgery of hiatal hernia with gastric volvulus.Methods A retrospective study was conducted to analyze the clinical data of 29 cases of hiatal hernia with gastric volvulus undergoing laparoscopic mesh repair and fundoplication at Beijing Chao-Yang Hospital from Jun 2021 to Dec 2022.Fundoplication was performed according to esophageal motility.The general data,operation times,intraoperative blood loss,percentage of intrathoracic stomach,hernia and gastric volvulus classification,conversion to open surgery,post-operative hospital stay and complications,symptom improvement rate,post-operative satisfaction were analyzed.Results Chronic obstruction symptoms were the most common complaint among the 29 patients.All the operations were done laparoscopicaly with no conversion case,19(65%)cases with type II hiatal hernia,20(70%)cases with organoaxial gastric volvulus,average operating time was(110.2±33.3)min,average blood loss was(12.6±7.0)ml,percentage of intrathoracic stomach 75.9%±15.8%,length of hernia defect was(6.6±1.2)cm,width of hernia defect was(5.0±1.1)cm.Average post-operative hospital stay was(6.4±1.7)days,perioperative complications were pneumonia(7%),atelectasis(7%)and gastric motility disorder(3%).All the patients were followed up for 15 to 32 months,without report of patch infection,long-term chronic pain,intestinal obstruction and hernia recurrence.Postoperative symptom improvement rate was 90%,postoperative satisfaction rate was 90%.Conclusion Laparoscopic surgeryof hiatal hernia with gastric volvulus is a safe,feasible and effective method with satisfactory results.

关 键 词：疝 食管裂孔 胃扭转 疝修补术 腹腔镜 

分 类 号：R656[医药卫生—外科学]