不同类型补片联合Nissen胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素  

Efficacy of different types of mesh combined with Nissen fundoplication for repairing hiatal hernia and potential risk factors for recurrence

作　　者：周艳[1] 李盈 周小兵 程发辉 何恒正 Yan Zhou;Ying Li;Xiaobing Zhou;Fahui Cheng;Hengzheng He(Gastroesophageal Reflux Disease Center,Second People's Hospital of Hunan Province,Changsha 410011,China)

机构地区：[1]湖南省第二人民医院胃食管反流病诊疗中心,长沙410011

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第5期528-533,共6页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2020-16-1)。

摘　　要：目的探讨不同类型补片联合Nissen胃底折叠术修补食管裂孔疝(HH)的疗效及其潜在的复发危险因素。方法选取自2019年10月至2022年6月于湖南省第二人民医院行腹腔镜下补片修补联合Nissen胃底折叠术的120例HH患者,根据术中应用补片类型分为试验组(脱细胞猪小肠黏膜下层基质源生物补片)及对照组(聚丙烯补片),回顾性分析2组HH患者术后疗效,并通过Logistic回归分析进一步探讨潜在的复发危险因素。结果2组患者术后胃食管反流病问卷量表(Gerd Q)评分[(7.6±1.8)分、(7.8±1.2)分]均较术前降低[(11.2±3.0)分、(11.1±3.2)分],差异有统计学意义(t=7.971、7.479;P<0.001、<0.001);单因素分析结果表明HH术后复发与患者年龄(OR=3.211,95%CI=1.831~5.191,P=0.012)、术后反酸(OR=3.385,95%CI 1.525~6.213;P=0.013)、术后吞咽困难(OR=3.512,95%CI=1.902~5.914;P=0.022)、裂孔缺损直径(OR=5.810,95%CI=3.2261~9.993;P=0.020)、术后住院时间(OR=2.426,95%CI=1.421~4.270;P=0.027)、术后食管压力(OR=0.372,95%CI=0.105~0.823;P=0.019)及术后DeMeester评分(OR=1.916,95%CI=1.022~4.885;P=0.013)具有相关性;进一步多因素Logistic回归分析发现,术后反酸(OR=3.518,95%CI=1.050~5.423;P=0.013)、术后吞咽困难(OR=3.307,95%CI=1.384~7.065;P=0.011)、裂孔缺损直径大(OR=3.673,95%CI=1.821~10.368;P=0.016)、术后住院时间长(OR=7.025,95%CI=4.313~16.335;P=0.017)、术后食管压力高(OR=14.013,95%CI=7.735~21.926;P=0.007)、术后DeMeester评分高(OR=15.342,95%CI=3.024~24.012;P=0.004)均是HH复发的独立危险因素。结论无论应用生物或合成补片联合Nissen胃底折叠修补术均能安全、有效修补HH,且改善患者预后。裂孔缺损直径大、术后出现反酸及吞咽困难、术后住院时间长、术后食管压力高、术后DeMeester评分高均提示HH复发高风险,临床治疗?选择补片?应遵循个体化原则。Objective To investigate the effect of different meshes combined with Nissen fundoplication for repairing hiatal hernia(HH)and potential risk factors for recurrence.Methods A total of 120 patients with HH underwent laparoscopic mesh repair combined with Nissen fundoplication in Second People&apos;s Hospital of Hunan Province from October 2019 to June 2022 were selected.According to intraoperative type of mesh,patients were divided into the experimental group(decellularized porcine small intestinal submucosa-derived biological mesh)and the control group(polypropylene mesh).The postoperative efficacy of the two groups of HH patients were retrospectively analyzed,and the potential risk factors for recurrence were further explored by Logistic regression analysis.Results The postoperative gastroesophageal reflux disease questionnaire(Gerd Q)scores[(7.6±1.8),(7.8±1.2)points]of both groups of patients decreased compared to preoperative scores[(11.2±3.0),(11.1±3.2)points],with statistically significant difference(t=7.971,7.479;P<0.001,<0.001).The results of univariate analysis showed that postoperative recurrence of HH was associated with age(OR=3.211,95%CI=1.831-5.191;P=0.012),postoperative acid reflux(OR=3.385,95%CI=1.525-6.213;P=0.013),postoperative dysphagia(OR=3.512,95%CI=1.902-5.914;P=0.022),hiatal defect diameter(OR=5.810,95%CI=3.2261-9.993;P=0.020),postoperative hospital stay(OR=2.426,95%CI=1.421-4.270;P=0.027),postoperative esophageal pressure(OR=0.372,95%CI=0.105-0.823;P=0.019)and postoperative DeMeester score(OR=1.916,95%CI=1.022-4.885;P=0.013).Further multivariate Logistic regression analysis showed that postoperative acid reflux(OR=3.518,95%CI=1.050-5.423;P=0.013),postoperative dysphagia(OR=3.307,95%CI=1.384-7.065;P=0.011),large hiatal defect diameter(OR=3.673,95%CI=1.821-10.368;P=0.016),long postoperative hospital stay(OR=7.025,95%CI=4.313-16.335;P=0.017),high postoperative esophageal pressure(OR=14.013,95%CI=7.735-21.926;P=0.007)and high postoperative DeMeester score(OR=15.342,95%CI=3.024-24.012;P=0.00

关 键 词：疝 食管裂孔 生物补片 疝修补术 NISSEN胃底折叠术 疗效 复发危险因素 

分 类 号：R655.4[医药卫生—外科学]