腹腔镜食管裂孔修补和胃底折叠术的临床应用(附45例报告)

Laparoscopic antireflux surgery in treating gastroesophageal reflux disease (a report of 45 cases)

目的总结腹腔镜食管裂孔疝修补和胃底折叠术治疗胃食管反流性疾病的经验。方法回顾性分析2000年1月以来45例腹腔镜食管裂孔疝修补和胃底折叠术的临床资料,其中男32例,女13例,平均年龄51.9岁(25～78岁);胃底折叠方法包括Niseen术式33例、Rossetti术式10例、Toupet术式2例(含1例复发的食管裂孔疝再手术)。结果手术用时45～120min,术中失血10～100mL,无中转开腹和手术死亡病例。1例术中撕裂胸膜致气胸,1例术后出现轻度胃排空障碍,4例术后有轻度吞咽梗阻感。术后平均住院4.7d,随访3～75个月仅1例患者胃镜提示食管炎复发。结论腹腔镜食管裂孔疝修补和胃底折叠术治疗胃食管反流疾病是安全有效的,应根据患者的食管动力状态和解剖选择完全折叠或部分折叠术式。

[Objective] To summarize the experience of laparoscopic antireflux procedure in managing gastroesophageal reflux disease（GERD）. [Methods] The operation of hiatus hernia repair plus fundoplieation performed by our team were retrospeetively reviewed. There were 32 male cases and 13 female cases with the mean age of 51.9 years （ranging from 25-78 years）. Forty-five patients diagnosed as GERD received hernia repair plus fundoplicafion （33 Nissen, 10 Rossetti, 1 Toupet, 1 recurring ease received hiatus hernia repair plus reconstruction of the wrap in a Toupet fashion）. [Results] The operating time was 45-120 rain and blood loss 10-100 mL. There was no conversion to open surgery or death. One ease was found to have pneumothorax and was eured after taking drainage for 1 day. No severe complications appeared in our group. The average post-operative stay was 4.7 day. All the symptoms disappeared after the operations. The prognosis was exeellent with only one recurring ease after 3-75 months follow-up. [Conclusions] Laparoscopic antireflux procedure is an effective and safe method and should be individualized aecording to esophageal motor function and local anatomy.