腹腔镜胃底180°前折叠术治疗食管裂孔疝疗效分析

Curative effect analysis of laparoscopic esophageal hiatal hernia repair and anterior 180 degreespartial fundoplication

目的探讨腹腔镜食管裂孔疝修补联合胃底180°前折叠术治疗食管裂孔疝疾病的可行性和安全性。方法回顾性分析了沧州市中西医结合医院与天津南开医院2008年9月至2013年6月采用腹腔镜技术治疗的180例食管裂孔疝患者资料，其中30例应用补片修补裂孔，剩余患者丝线缝合裂孔，均加做胃底180°前折叠（Dor手术）。结果手术顺利，无中转开腹者。术后随访3～60个月，手术效果满意率92.31％，术后3个月复查胃镜、上消化道造影等检查基本恢复正常。其中7例患者术后早期出现轻度反酸、烧心症状，均在4个月内通过保守治疗好转，无复发病例，无严重吞咽困难病例。结论腹腔镜食管裂孔疝修补和胃底180°前折叠术治疗食管裂孔疝疾病有微创手术创伤小、恢复快、安全可行、疗效可靠等特点，值得临床广泛应用。

Objective To explore the feasibility and safety of laparoscopic hiatal hernia repair and anterior 180 degrees partial fundoplication for the treatment of esophageal hiatal hernia. Methods The clinical data of 180 patients who under went laparoseopie surgery for esophageal hiatal hernia from September 2008 to June 2013 at Cangzhou hospital of ITWM and Nankai hospital of Tianjin were retrospectively analyzed.All cases were conducted anterior 180 degrees partial fundoplication, including patch repair was used in 30 patients and silk sutures were used for the repair of esophageal perforation in the rest patients. Results All operations were performed smoothly, no conversions were needed.After the follow up period of 3 ~ 60 months,the satisfaction rate of operation was 92.31%. The symptoms in most cases were adequately relieved after operation.Endoscopy,radiology were repeated 3 months after surgery. Seven cases had mild symptom recurrence of acid reflux relieved with in 4 months,no case occulted severely dysphagia and recurrence. Conclusion Laparoseopic repair of esophageal hiatal hernia and 180 degrees partial fundoplication has the following advantages：minimized trauma, quick recovery,safe and reliable effect procedures for hiatal hernia.