腹腔镜食管裂孔疝修补联合Nissen胃底折叠术在食管裂孔疝合并胃食管反流病中的应用  

Application of laparoscopic repair of esophageal hiatal hernia combined with Nissen fundus folding surgery in treatment of esophageal hiatal hernia combined with gastroesophageal reflux disease

作　　者：薄霞 程领 张玉珠 BO Xia;CHENG Ling;ZHANG Yu-zhu(Department of Thoracic Surgery Ward 1,the First Affliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院胸外科一病区,郑州450000

出　　处：《医药论坛杂志》2025年第2期189-193,共5页Journal of Medical Forum

摘　　要：目的 食管裂孔疝患者并发胃食管反流病(gastroesophageal reflux disease,GERD)后采取腹腔镜Nissen胃底折叠术(laparoscopic Nissen fundoplication,LNF)、食管裂孔疝修补术结合方案的效果探究。方法 回顾性研究选取2022年6月—2023年6月郑州大学第一附属医院接收的并发胃食管反流病的食管裂孔疝患者153例,将采用传统开腹术治疗的72例作为对照组,将采用Nissen胃底折叠术+腹腔镜食管裂孔疝修补术治疗的81例作为联合组,比较两组的围手术期指标、术后并发症发生率差异,比较两组食管反流情况和术后抗反流效果差异。结果 联合组的手术时间(79.24±10.12)min、出血量(35.69±16.44)mL、胃肠功能恢复时间(1.46±0.94)d及住院时间(6.68±1.53)d,均低于对照组,差异有统计学意义(P<0.05);两组的术后胸腔积液、肺炎发生率比较,差异无统计学意义(P>0.05);术前两组的食管反流次数、反流时间、长反流次数及GerdQ评分比较,差异无统计学意义(P>0.05),术后均低于同组术前,差异有统计学意义(P<0.05),且联合组术后6个月的食管反流次数、反流时间、长反流次数及GerdQ评分分别为(11.85±1.32)次、(0.68±0.15)h、(0.35±0.14)次及(6.02±0.33)分,均低于对照组,差异均有统计学意义(P<0.05);联合组的术后并发症发生率10.00%,低于对照组的27.50%,差异有统计学意义(P<0.05)。结论 对食管裂孔疝并发胃食管反流患者行腹腔镜食管裂孔疝修补术及Nissen胃底折叠术时能够改善食管反流情况,且术后恢复时间短,术后并发症风险低,值得推广。Objective To explore the effectiveness of the combined plan of Nissen gastric fundus folding surgery and laparoscopic esophageal hiatal hernia repair in patients with esophageal hiatal hernia complicated by gastroesophageal reflux disease.Methods A retrospective study of 153 patients with esophageal hiatus hernia complicated with gastroesophageal reflux disease admitted to the First Affiliated Hospital of Zhengzhou University from June 2022 to June 2023 was conducted.Among 72 patients treated with traditional laparotomy were selected as the control group,and 81 patients treated with Nissen fundus folding surgery plus laparoscopic hiatus hernia repair were selected as the combined group.The perioperative indicators and postoperative complication rates of the two groups were compared,as well as the differences in esophageal reflux situation and postoperative anti reflux effect between the two groups.Results The surgery time of(79.24± 10.12) minutes,bleeding volume of(35.69 ± 16.44) mL,gastrointestinal function recovery time of(1.46±0.94) days,and hospitalization time of(6.68±1.53) days in the combined group were all lower than those in the control group,and the differences were ststistically significant(P<0.05);comparison of postoperative pleural effusion and pneumonia incidence between two groups,and the differences were not ststistically significant(P>0.05).The number of esophageal reflux episodes,reflux time,long reflux episodes and GerdQ scores of the two groups before operation were compared,and the difference were not statistically significant(P>0.05),and they were lower after operation than before operation in the same group,and the differences were statistically significant(P<0.05).The number of esophageal reflux episodes,the duration of reflux time,the number of long-time reflux episodes and the GerdQ score in the combined group were 11.85±1.32,0.68±0.15,0.35±0.14 and 6.02±0.33,respectively,which were lower than those in the control group,and the differences were statistically significant(P<0.05).T

关 键 词：腹腔镜食管裂孔疝修补术 NISSEN胃底折叠术 胃食管反流 

分 类 号：R655.4[医药卫生—外科学]