腹腔镜治疗食管裂孔疝术后吞咽困难的比较

Comparison of dysphagia incidence after laparoscopic Nissen and Toupet fundoplication for hiatal hernia repair

目的:探讨食管裂孔疝行腹腔镜裂孔修补术加Nissen360°胃底折叠术和Toupet270°胃底折叠术后吞咽困难的发生率.方法:回顾分析天津市南开医院2012-02/2014-02采用腹腔镜技术治疗的64例食管裂孔疝患者资料,其中行腹腔镜Nissen360°胃底折叠术32例,行腹腔镜Toupet270°胃底折叠术32例.对两组术后吞咽困难的发生率、术后反酸发生率、手术时间、术中出血量、术后Demeester评分及术后住院时间进行观察,并进行统计学分析.结果:术后Nissen组有6例出现吞咽困难,这6例吞咽困难病例均未使用补片修补,予对症治疗3 mo后,4例吞咽困难仍不能缓解,行胃镜下扩张术后症状缓解;有1例术后出现轻度反酸,经抑酸治疗后症状缓解.术中Toupet组有1例巨大食管裂孔疝使用补片修补,术后Toupet组未出现吞咽困难病例,有2例患者出现轻度反酸,经抑酸、促进胃动力治疗后症状消失.术后吞咽困难的发生率Nissen组高于Toupet组,比较有统计学差异(P<0.05).两组间手术时间、术中出血量、术后反酸的发生率、术后Demeester评分及术后住院时间差异无统计学意义(P>0.05).结论:食管裂孔疝患者行Nissen360°胃底折叠术术后吞咽困难的发生率高于行Toupet270°胃底折叠术.

AIM：To compare the incidence rate of dysphagia after laparoscopic Nissen and Toupet fundoplication for hiatal hernia repair.METHODS：Clinical data for 64 patients who underwent laparoscopic hiatal hernia repair from February 2012 to February 2014 at Tianjin Nankai Hospital were retrospectively analyzed,including 32 cases of Nissen fundoplication and 32 cases of Toupet fundoplication.RESULTS：After 4 to 24 months of followup,the incidence rate of dysphagia after laparoscopic Nissen fundoplication was significantly higher than that after laparoscopic Toupet fundoplication（P〈0.05）.CONCLUSION：The incidence rate of dysphagia after laparoscopic Nissen fundoplication for hiatal hernia repair was significantly higher than that after Toupet fundoplication.