单纯缝合和补片加固治疗食管裂孔疝的对比研究

Comparative study of the treatment of hiatal hernia simple suture and mesh reinforcement

目的对比单纯膈肌脚缝合法和补片加固修补法治疗食管裂孔疝的效果,评价复发率和并发症。方法回顾性分析2002年1月至2012年12月,第二军医大学附属长征医院行腹腔镜下食管裂孔疝修补术胃食管反流病患者77例的临床资料。根据是否应用补片加固分为二组,其中31例采用单纯膈肌脚缝合法,为A组;46例采用补片加固修补法,为B组。分析单纯缝合及补片加固缝合术后食管裂孔疝的复发率及补片相关并发症。结果从短期随访结果看,B组术后Visick评分明显高于A组(P=0.007),反流症状明显改善;A组食管裂孔疝复发率明显高于B组,差异无统计学意义,术后吞咽困难发生率比较,差异无统计学意义。从长期随访结果看,B组的手术满意度明显高于A组(P=0.019),A组食管裂孔疝复发率明显高于B组,接近于统计学差异(P=0.05),术后吞咽困难发生率差异无统计学意义。结论补片加固缝合可显著改善反流相关症状,提高患者满意度并降低食管裂孔疝复发的风险,但没有显著增加补片相关并发症的风险,这可能与补片材质、使用指征及固定技巧的改进密切相关。

Objective To compare the efficacy of simple suture and mesh repair for esophageal hiatal hernia and to evaluate recurrence and complications.Methods The study retrospectively included 77 patients with gastroesophageal reflux disease who underwent laparoscopic esophageal hiatal hernia repair from January 2002 to December 2012.According to the application of mesh reinforcement,patients were divided to 2 groups.Thirty-one patients who underwent simple suture were allocated into A group while 46 patients who underwent mesh reinforcement were allocated into B group.Recurrence and complications were both evaluated.Results For the short-term results,Visick score was higher in B group compared with that in A group （P =0.007）.Reflux symptoms significantly improve.Hiatal hernia recurrence was higher in A group compared with B group, but without significantly difference. Postoperative dysphagia failed to show significantly statistical difference between 2 groups.For the long-term results,degree of operative satisfaction was significantly higher in B group compared with A group （P =0.019）.Recurrence of hiatal hernia was higher in A group,which tends to be a significantly statistical difference （P =0.05 ）.The rate of postoperative dysphagia was not significantly different between 2 groups.Conclusion Mesh reinforcement of hiatal hernia could significantly relief reflux-related symptoms,improve degree of operative satisfaction and decrease risk of recurrence of hiatal hernia.However,mesh-related complications did not increase.The improvement of mesh texture,indication and repair techniques contribute to these results.