腹腔镜下食管裂孔疝修补术后吞咽困难的危险因素分析  

Analysis of risk factors for dysphagia after laparoscopic hiatal hernia repair

作　　者：杜晨阳 王勇[1] 段鑫[1] 柯文杰[1] 石念 武英翔 罗文[1] Chenyang Du;Yong Wang;Xin Duan;Wenjie Ke;Nian Shi;Yingxiang Wu;Wen Luo(Department of Hernia and Abnominal Wall Surgery,The Central Hospital of Wuhan,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院疝与腹壁外科,430014

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第5期523-527,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：湖北省卫生健康委联合基金立项项目青年重点项目(WJ2019H382)。

摘　　要：目的探讨腹腔镜下食管裂孔疝修补术后吞咽困难的独立危险因素。方法回顾性分析2016年1月1日至2022年12月31日在华中科技大学同济医学院附属武汉中心医院疝与腹壁外科行腹腔镜下食管裂孔疝修补术的42例患者的临床资料。分别采用χ^(2)检验和Logistics回归分析进行多因素分析,统计分析患者术后发生吞咽困难的危险因素。结果42例患者中,男性25例,女性17例;年龄24~78岁,平均(63.47±4.77)岁。术后15例患者发生进食后吞咽困难。Logistic回归分析显示,食管裂孔直径、术前食管测压结果、是否存在睡眠障碍及胃底折叠方式是评价腹腔镜下食管裂孔疝修补术后出现吞咽困难的独立危险因素(P<0.05)。结论腹腔镜下食管裂孔疝修补术后患者出现进食后吞咽困难的主要原因考虑与食管裂孔疝直径、术前食管测压水平、睡眠质量及胃底折叠方式等因素密切相关,在临床诊疗过程中可根据患者个体情况进行个体化治疗,以最大程度减轻患者术后进食哽噎及吞咽困难症状,促进患者的快速康复。Objective To investigate the independent risk factors of dysphagia after laparoscopic hiatal hernia repair.Methods The clinical data of 42 patients who underwent laparoscopic hiatal hernia repair at the Department of Hernia and Abdominal Wall Surgery,Wuhan Central Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 1,2016 to December 31,2022,were retrospectively analyzed.The chi-square test and logistic regression analysis were used for multivariate analysis respectively,and the risk factors of postoperative dysphagia were statistically analyzed.Results Among the 42 patients,25 were male and 17 were female,and the age ranged from 24 to 78 years old,with an average of(63.47±4.77)years old.After operations,15 patients developed dysphagia after eating.The diameter of the esophageal hiatus,the results of preoperative esophageal manometry,the existence of sleep disturbance and gastric fundus folding were independent risk factors for dysphagia after laparoscopic hiatal hernia repair(P<0.05).Conclusion The main reasons for dysphagia after eating in patients after laparoscopic hiatal hernia repair are closely related to factors such as the diameter of the esophageal hiatus,preoperative esophageal manometry,sleep quality and fundus fold.Individualized treatment is carried out to minimize the symptoms of postoperative choking and dysphagia,and to promote the rapid recovery of patients.

关 键 词：疝 食管裂孔 胃食管反流 胃底折叠 腹腔镜 吞咽困难 抑郁 

分 类 号：R655.4[医药卫生—外科学]