生物补片修补食管裂孔疝的效果：1年随访

Effect of biological mesh on hiatal hernia repair: One-year follow-up

背景:尽管腹腔镜食管裂孔疝修补已取得良好的治疗效果,但对术中是否应该使用生物补片仍存在争议。目的:分析生物补片修补腹腔镜食管裂孔疝的效果。方法:回顾性分析2006-11/2009-06在复旦大学附属华山医院实施手术的57例食管裂孔疝患者临床资料,其中单纯膈肌脚缝合+Nissen胃底折叠24例(对照组),单纯膈肌脚缝合+Nissen胃底折叠同时行补片加强33例(实验组)。对比分析使用补片和未使用补片的治疗结果。结果与结论:术后随访1年,实验组与对照组术后复发率、患者满意度、症状控制情况差异均无显著性意义(P>0.05)。与对照组比较,实验组术中、术后并发症并未增加,同时手术时间及住院时间也未明显延长(P>0.05)。短期随访结果说明补片加强修补食管裂孔疝是安全、有效的,但应严格掌握适应证。

BACKGROUND： Although laparoscopic hiatal hernia repair had achieved good therapeutic effect, there is a debate addressing whether the biological mesh was used for surgery. OBJECTIVE： To analyze the effect of laparoscopic hiatal hernia repair with biological mesh. METHODS： To retrospectively analyze clinical data of 57 patients with esophageal hiatal hernia, all of whom were accepted surgical treatment at Huashan Hospital Affiliated to Fudan University from November 2006 to June 2009, including 24 cases with simple diaphragm feet suture and Nissen fundoplication （control group）, 33 cases with simple diaphragm feet suture and Nissen fundoplication were undergoing mesh reforcement simultaneously （experimental group）. The therapeutic results of laparoscopic hiatal hernia repair were compared and analyzed with or without mesh. RESULTS AND CONCLUSION： During 1 year follow-up, there was no significant difference between the control and experimental groups, including recurrence rate, patient satisfactory and symptom control （P 0.05）. Compared with the control group, the intraoperative and postoperative complications were not increased in experimental group; meanwhile, operation interval and hospital stay were not significantly longer either （P 0.05）. The short-term follow-up results showed that laparoscopic hiatal hernia repair with mesh was safe and effective, but indications should be strictly controlled.