腹腔镜下治疗食管裂孔疝55例报告

Clinical Experience of Laparoscopic Repair of Esophageal Hiatal Hernia

目的：探讨腹腔镜下治疗食管裂孔疝的可行性和有效性。方法2008年3月～2013年3月腹腔镜手术治疗55例食管裂孔疝，腹腔镜下完成食管裂孔疝的还纳及修补之后，进一步行胃底折叠术。结果55例均在腹腔镜下完成手术，在食管裂孔修补基础上辅以不同的胃底折叠术，其中Nissen胃底折叠术17例，Toupet 胃底折叠术19例，Dor胃底折叠术19例。3种术式的手术时间：Nissen术式（69．6±13．0）min，Toupet术式（68．0±8．2）min，Dor术式（63．8±10．1）min；3种术式的术中出血量：Nissen术式（20．0±5．8）ml，Toupet术式（20．6±9．5）ml，Dor术式（21．7±5．0）ml，无一例输血；3种术式的术后拔管时间：Nissen术式（3．1±1．1） d，Toupet术式（2．7±0．7） d，Dor术式（2．3±1．1） d；3种术式的术后住院时间：Nissen术式（9．1±4．9）d，Toupet术式（8．4±2．6）d，Dor术式（7．6±1．5）d。术后患者的临床症状均得到有效缓解，无围术期死亡，3例（5．4％）出现术后并发症，其中2例胃排空障碍，1例吞咽困难，治疗后均缓解。55例中位随访时间45个月（6～60个月），口服钡餐造影或胃镜等检查无食管裂孔疝复发，无食管狭窄和食管憩室发生。结论腹腔镜下治疗食管裂孔疝安全有效，可根据病人的情况选择不同的胃底折叠术。

Objective To explore the feasibility and effectiveness of laparoscopic repair of esophageal hiatal hernia . Methods We retrospectively analyzed clinical data of 55 patients with esophageal hiatal hernia who underwent laparoscopic surgery in our hospital between March 2008 and March 2013.After laparoscopic repair of esophageal hiatal hernia , different types of fundoplication were carried out including Nisse fundoplication in 17 cases, Toupet fundoplication in 19 cases, Dor fundoplication in 19 cases. Results All the operations were successfully completed under laparoscope .Different fundoplication included 17 cases of Nissen fundoplication, 19 cases of Toupet fundoplication, and 19 cases of Dor fundoplication.The operative time was （69.6 ±13.0） min for Nissen operation, （68.0 ±8.2） min for Toupet operation, and （63.8 ±10.1） min for Dor, respectively.The intraoperative blood loss was （20.0 ±5.8） ml for Nissen operation, （20.6 ±9.5） ml for Toupet, and （21.7 ±5.0） ml for Dor, respectively.No blood transfusion was needed .The postoperative extubation time was （3.1 ±1.1） d for Nissen operation, （2.7 ±0.7） d for Toupet, and （2.3 ±1.1） d for Dor, respectively.The postoperative hospital stay was （9.1 ±4.9） d for Nissen operation, （8.4 ±2.6） d for Toupet, and （7.6 ±1.5） d for Dor, respectively.Clinical symptoms had been alleviated effectively after operation , without deaths. However, 3 patients （5.5%） had developed postoperative complications , including 2 cases of delayed gastric emptying and 1 case of dysphagia, which were relieved after treatment.The median follow-up time was 45 months （range, 6-60 months）.Oral barium meal and endoscopic examinations showed no recurrence of hiatal hernia , esophageal stenosis , or esophageal diverticula . Conclusion Laparoscopic repair of esophageal hiatal hernia is safe and effective , and different fundoplications can be chosen according to conditions of patients .