腹腔镜在先天性食管裂孔疝修补术中的应用

Application of Laparoscopy to Repair of Congenital Esophageal Hiatal Hernia

目的探讨腹腔镜手术治疗小儿食管裂孔疝的安全性和疗效。方法2001年9月～2008年12月对7例小儿食管裂孔疝施行腹腔镜食管裂孔疝修补术联合胃底折叠术(Nissen法)。1例因术前上消化道造影发现合并胃排空延迟,联合实施了腹腔镜幽门成形术。1例合并右腹股沟斜疝同时行腹腔镜疝囊高位结扎术。1例术中发现合并副脾,未给予处理。结果7例患儿均在腹腔镜下完成食管裂孔疝修补联合胃底折叠术(Nissen法),无中转开腹者。手术时间平均94.2min(75～150min);术中出血量平均5ml(2～10ml),无术中术后输血者。术后24～48h进奶或进食。术后住院3～7d,平均4.5d。7例患儿术后随访6～20个月,平均12.6月。1例术后第10天出现呕吐,给予食管扩张和胃动力药物治疗后好转;1例术后1年复发,再次行腹腔镜食管裂孔疝修补联合Nissen胃底折叠术治愈;其余5例术后恢复顺利,无并发症发生。结论腹腔镜治疗食管裂孔疝创伤小,安全性好,疗效确切,可以联合治疗其他疾病,应注意适应证的选择。

Objective To investigate the efficacy and safety of laparoscopic repair in children with congenital esophageal hiatal hernia. Methods From September 2001 to December 2008, seven children with congenital esophageal hiatal hernia, including 4 boys and 3 girls, were treated by laparoscopic repair and Nissen＇ s fundoplieation in our hospital. One of them received laparoseopic pyloroplasty in the meanwhile because of delayed gastric emptying （confirmed by preoperative gastrointestinal angiography） ; one child underwent laparoscopic high ligation due to right oblique inguinal hernia; spleneolus was found in one patient, no further treatment was carried out. Results The procedures were completed in all of the patients without conversion to open surgery. The mean operation time was 94.2 rain （75 - 150 min） in this series, and the average blood loss was 5 ml （2 - 10 ml）. No patient received blood transfusion after the surgery. The children began to intake milk or regular diet in 24 - 48 hours after the operation. They were discharged from hospital in a mean of 4.5 days （ranged from 3 to 7 days）. Then, the children were followed up for 6 to 20 months （mean, 12.6 months）. One of the patients suffered from vomiting on the 10th day after the operation, 1 patient showed recurrence in 1 year postoperation and then was cured by a second operation. The other five patients were healthy during the follow-up. Conclusions Laparoscopic repair of congenital esophageal hiatal hernia is a safe, effective, and minimally invasive procedure. It is feasible for patients complicated with other diseases. The indications for the surgery must be strictly selected.