腹腔镜手术治疗1岁以内婴儿食管裂孔疝

Laparoscopic repair of esophageal hiatal hernia in infants Less than one year old.

目的探讨腹腔镜手术治疗1岁以内婴儿先天性食管裂孔疝的疗效及预后。方法1999年3月至2011年7月作者对19例先天性食管裂孔疝患儿实施腹腔镜下胃底折叠术。患儿平均年龄0．52岁，其中0-30d3例，31d至1岁16例。对患儿术前及术后3个月、6个月、12个月进行评估，以“呕吐、恶心”，“呼吸道感染”和“营养情况”做视觉模拟评分（VAS），以及食管钡餐造影（GI）和24h食管PH值监测，并对比结果。结果均采用腹腔镜食管裂孔疝修补术及胃底折叠术，其中Nis-sen-Rosetti’s术8例，改良Thai术11例，无中转开腹病例。平均手术时间120（90-170）min，平均住院时间9．25（5-12）d。术后随访伴呕吐及胃食管反流2例，吞咽困难1例，复发l例。食管裂孔疝引起的综合症状VAS评分术前为5．84±1．54，术后1、6、12个月分别为1．74±1．85、1．22±1．78、0．61±1．79，手术前后比较，差异均有统计学意义（P〈0．01）。结论采用腹腔镜胃底折叠术治疗婴儿严重胃食管反流的先天性食管裂孔疝，疗效好，恢复快，微创美观、安全可靠。

Objective To investigate the efficacy and outcome of laparoscopic repair for esophageal hia- tal hernia in infant Less than one year old. Method Retrospectively analyzed for 19 infants with esophageal hiatal hernia underwent laparoscopic hiatal hernia repair between March 1999 and July 2011 in our hospital. The mean age was 0.515 years old. （3 cases less than 30 days, 16 cases from 31 days to 1 year old）. Symp- toms of gastroesophageal reflux disease,including ＂ Vomit and nausea ＂, ＂ Respiratory tract infection ＂, ＂Nu- tritional status ＂ were evaluated by using visual analogue scales（VAS） preoperatively,and 3,6 and 12 months postoperatively. Results Laparoscopic fundoplication procedure （8 cases by Nissen - Rosetti＇ s fundoplication ,11 cases by modified Thal＇ s fundoplication） was completed in all the patients. There was no conversion to open surgery. The average operating time was 120 min （range, 90 to 170 min）. The mean hospital stay was 9. 25 days after operation （range, 5 to 12 days）. During the follow-up after operation,2 patients still with vomi- ting and gastroesophageal reflux, 1 with dysphagia, 1 patient recurrent. The VAS scores ＂mean ± standard de- viation ＂decreased from a preoperative score of 5.84 ± 1.54 to 1.74 ± 1.85,1.22 ± 1.78 and 0.61 ± 1.79, at after the surgery （P =0. 000,detected at 3,6 and 12 months respectively） . Conclusion Laparoscopic repair of esophageal hiatus hernia with serious gastroesophageal reflux in infant has the advantages of good efficacy, quick recovery, minimal invasion, and safety.