四孔法行腹腔镜食管裂孔疝修补术的疗效分析

Clinical effect analysis of four-port laparoscopic hiatal hernia repair

目的探讨四孔法腹腔镜食管裂孔疝修补术的优越性及可应用性。方法回顾性分析2009年4月至2013年1月,新疆巴州人民医院收治的12例食管裂孔疝患者的临床资料,患者均行四孔法腹腔镜裂孔疝修补术,其中Nissen胃底折叠术6例,Toupet胃底折叠术4例,Dor胃底折叠术2例。结果 12患者手术均顺利完成,手术时间60～200 min,平均120 min,失血量20～100 ml,术后平均住院6.4 d,术后2 d内进食,引流管在术后2 d内拔出。随访7～46个月,术后皮下纵膈气肿1例,其中2例行Nissen胃底折叠术术后1年内有明显吞咽困难,1年后吞咽困难症状逐渐缓解。结论四孔法行腹腔镜食管裂孔疝修补术具有安全可靠、手术时间短、创伤小、短期复发少、术后并发症少等优点。对于食管裂孔疝,四孔法腹腔镜食管裂孔疝修补术是一种安全、有效的治疗方法。

Objective To investigate the superiority and feasibility of four-port laparoscopic hiatal hernia repair. Methods A total of 12 patients of hiatal hernia underwent four-port laparoscopic hiatal hernia repair between April 2009 and January 2013 at Xinjiang Bazhou People＇s Hospital, and their clinical data were retrospectively analyzed, including 6 Nissen, 4 Toupet and 2 Dor fundoplication. Results All operations were successfully completed, and the mean operation time was 120 minutes （range 60 to 200 minutes）, blood loss was 20 to 100 ml, no intraoperative complications occurred. After repair, the mean duration of hospitalization was 6.4 days, food taking and drain removal were after 2 days. During 7 to 46 months follow-up, there was postoperative subcutaneous pneumomediastinum in 1 case. 2 patients with Nissen procedure developed obvious dysphagia, which improved at the 1-year follow-up. Conclusions Four-pert laparoscopic hiatal hernia repair has the advantages of safety, short operation time, minimally invasion,less short-term recurrence, and few postoperative comlications. It has proven to be a safe and effective procedure for esophageal hiatus.