腹腔镜巨大食管裂孔疝修补术75例临床分析

Laparoscopic repair for giant hiatal hernia:A clinical analysis of 75 patients

目的 探讨腹腔镜治疗巨大食管裂孔疝手术安全性及有效性。方法 回顾性分析2006年1月至2012年8月天津市南开医院微创外科采用腹腔镜治疗75例巨大食管裂孔疝病人的病例资料。观察手术时间、住院时间、术中及术后并发症、术后主观症状和客观检查随访结果。结果 75例成功行腹腔镜巨大食管裂孔疝修补术。51例放置补片， 24例未放置补片。40例部分关闭、缩小食管裂孔，均放置补片；35例完全关闭食管裂孔至正常，其中11例放置补片。64例术中联合胃底折叠术。手术时间（97.2±2.1）min，术中出血（82.0±1.7）mL，住院时间（5.0±1.2）d。无死亡及中转开胸或开腹病例。17例出现近期和远期并发症，并发症发生率22.7%。随访3～62个月，平均（31.0±2.1）个月。66例（88%）术后主要症状得到缓解，9例（12%）出现症状，钡餐随访裂孔疝复发4例（5.3%）。结论 腹腔镜治疗巨大食管裂孔疝是一种安全、有效的术式，放置补片能有效降低术后复发率，但存在补片并发症风险。

Objective To investigate the safety and effectiveness of laparoscopic repair for giant hiatal hernia. Methods The clinical data of 75 patients with giant hiatal hernia performed laparoscopic repair between January 2006 and August 2012 in Tianjin Nankai Hospital were analyzed retrospectively. The operation time, hospitalization time, intraoperative and postoperative complications, postoperative improvement of symptoms and upper gastrointestinal imaging were studied. Results All the patients were treated by laparoscopy successfully. Fifty-one patients were reinforced with meshes. Twenty-four patients were reinforced without mesh. Hiatal pillars in 40 patients were partly contracted and closed with meshes. Hiatal pillars in 35 patients were directly closed up to normal diameter by interrupted stitches. Among them, 11 patients were placed with meshes. Laparoscopic repair complicated with fundoplication was performed in 64 patients with average operation time of （97.2±2.1）min, average operative blood loss of （82.0±1.7）mL and average hospital stay of （5.0±1.2）d. No conversion and death occurred. Seventeen patients （22.7%） had short-term or long-term complications. Seventy-five patients were followed up for 3 months to 62 months with average of （31.0±2.1）months. Main symptoms of 66 patients （88%） were disappeared. Nine patients （12%）had recurrence of symptoms. Four patients（5.3%）were found recurrence by barium swallow. Conclusion Laparoscopic repair for giant hiatal hernia is safe and reliable. Mesh repair can reduce the recurrence rate but accompanied with risk of complication.