四孔法腹腔镜手术治疗食管裂孔疝的疗效分析

Analysis of curative effect of four-port laparoscopic operation for the treatment of esophageal hiatal hernia

目的：探讨四孔法腹腔镜手术治疗食管裂孔疝的安全性、可行性及临床应用价值。方法：回顾分析2010年1月至2015年1月为27例食管裂孔疝患者行四孔法腹腔镜裂孔疝修补术的临床资料,其中9例行Nissen胃底折叠术,6例行Toupet胃底折叠术,12例行Dor胃底折叠术;22例患者应用补片修补。术前患者均行食管下段括约肌压力测试,24 h p H值监测。结果：27例手术均获成功,手术时间52~105 min,平均（90.0±21.3）min;术中出血量10~20 ml,平均（12.0±2.5）ml。术后住院5~12 d,平均（7.0±1.2）d。术后随访3~60个月,平均（26.0±3.5）个月,术后症状完全消失20例,好转7例,无吞咽困难及疝复发患者。结论：四孔法腹腔镜手术治疗食管裂孔疝安全、可行、有效,术中精细操作及个体化的治疗措施可有效改善患者的生活质量,提高治愈率,减少术后并发症的发生。

Objective：To investigate the safety,feasibility and value of four-port laparoscopic operation for the treatment of e- sophageal hiatal hernia. Methods： The clinical data of 27 patients who underwent four-port laparoscopic operation for the treatment of e- sophageal hiatal hernia from Jan. 2010 to Jan. 2015 were retrospectively analyzed. The patients underwent Nissen fundoplication in 9 ca- ses ,Toupet fundoplieation in 6 cases ,Dor fundoplicatinn in 12 cases, 22 cases were repaired with patch. The patients underwent lower esophageal sphincter pressure test and 24 h pH monitoring. Results： All operations were successful. The mean operative time was （90.0 ± 21.3 ） min, with a range from 52 to 105 min, the mean amount of bleeding was （ 12.0 ± 2.5 ） ml, with a range from 10 to 20 ml. Post- operative hospital stay ranged from 5 to 12 d,with the average of （7.0 ± 1.2） d. The patients were followed up for 3 to 60 months [ mean, （26.0 ± 3.5 ） months ], postoperative symptoms completely disappeared in 20 cases, 7 cases were improved, no dysphagia or hernia recurrence was found after operation. Conclusions ： Four-port laparoscopic repair of esophageal hiatal hernia is a kind of method that is feasible, safe and effective. Fine operation and individualized treatment can effectively improve quality of life, increase cure rate and decrease postoperative complications.