经胸入路小儿食管裂孔疝14例外科治疗

Transthoracic approach for surgical treatment of esophageal hiatal hernia in 14 children

目的：探讨经胸入路小儿食管裂孔疝外科治疗的方法并观察临床效果。方法：应用左侧经胸入路食管裂孔疝修补附加Belsey方法抗胃食管反流手术治疗小儿食管裂孔疝14例。3例诊断为滑动性疝（Ⅰ型）,1例为食管旁疝（Ⅱ型）,余10例为混合性疝（Ⅲ型）。结果：14例均顺利完成手术,手术130~180 min,术后3~11天拔管,住院15~31天。患儿均痊愈出院,随访3个月至2年,患儿体重增加,营养良好,无复发。结论：经非手术治疗无效的Ⅰ型食管裂孔疝和Ⅱ、Ⅲ型食管裂孔疝应早期手术治疗,左侧经胸入路食管裂孔修补术附加Belsey方法抗胃食管反流手术视野暴露好,操作方便,损伤相邻器官少,修补准确,切口隐蔽美观,术后吞咽困难发生率低,临床效果满意。

Objective：To explore the operating approach and clinical efficacy of transthoracic approach for surgical treatment in children with esophageal hiatal hernia（HH）.Methods：Fourteen children with HH were treated by operative repair through the left thoracical route and Belsey′s antireflux surgery.Three of which were sliding hiatus hernia（typeⅠ）,one of which was paraesophageal hernia（typeⅡ）,and another 10 children were mixed hernia（type Ⅲ）.Results：The procedures were successfully completed in all patients and had good outcome.The operation time was 130-180 min,length of hospitalisation was 15-31 days,and the extubation time was 3-11 days after operation.All patients were followed up from 3 months to 2 years,the preoperative symptoms were disappeared.The children had gained weight and height,and were healthy during the follow-up.Conclusions：The children in Type Ⅰwhose symptoms cannot be controlled by drug measures and the children in TypeⅡ,Ⅲ should do early surgical treatment.Transthoracic approach operative repair of HH and Belsey′s antireflux surgery is a kind of technique with good operative field,small concealing incision,easy to operate and repair,and low dysphagia incidence.It is an effective and practical approach for the surgical treatment of HH.