腹腔镜手术治疗食管裂孔疝、反流性食管炎合并胆囊结石27例

Laparoscopic Therapy for Esophageal Hiatus Hernia and Reflux Esophagitis Complicated with Cholecystolithiasis:Report of 27 Cases

目的探讨腹腔镜手术同时治疗食管裂孔疝、反流性食管炎合并胆囊结石的可行性。方法采用五孔法。先行腹腔镜食管裂孔疝修补,再行胃底折叠术（21例行Nissen胃底折叠术,6例行Toupet胃底折叠术）,最后行LC。结果27例均顺利完成了手术,术后食管内压力（19.32±4.11）mm Hg,显著高于术前（7.30±1.36）mm Hg（t=-16.407,P=0.000）;术后24 h食管pH值9.20±2.15,显著低于术前160.16±50.30（t=16.387,P=0.000）。无出血、腹腔感染、胆漏等并发症。27例随访1-24个月（其中7例随访1-6个月,20例随访7-24个月）,无食管狭窄、切口疝等并发症的发生。结论食管裂孔疝、反流性食管炎合并胆囊结石的患者一期行腹腔镜手术可行。

Objective To explore the feasibility of laparoseopie surgery for esophageal hiatus hernia and reflux esophagitis complicated with eholeeystolithiasis. Methods Five troears were used for the patients to perform laparoscopie hiatal hernia repair, followed by fundoplieation （Nissen fundoplication in 21 cases and Toupet fundoplication in 6 ）, and then LC. Results The procedures were completed in all of the 27 cases. The postoperative mean esophageal pressure of the patients was significantly higher than that before the operations [（19.32±4.11） mm Hgvs （7.30±1.36） mmHg, t= -16.407,P=0.000], while the 24 -hourpH value were decreased markedly （9. 20 ±2.15 vs 160. 16 ±50. 30, t = 16. 387, P = 0. 000）. No hemorrhage, intra-abdominal infection, biliary leakage occurred in this series. The patients were followed up for 1 to 24 months （ 1 - 6 months in 7 cases, and 7 - 24 months in 20 eases） , during which no esophageal stenosis or incisional hernia were detected. Conclusions It is feasible to perform primary laparoscopie surgery for patients suffering from esophageal hiatus hernia and reflux esophagitis complicated with simultaneous eholeeystolithiasis, if no eontraindications.