食管裂孔疝致胃食管反流病合并腹股沟疝患者的外科治疗

The surgical treatment of hiatal hernia combined with gastroesophageal reflux disease and inguinal hernia

目的:探讨食管裂孔疝致胃食管反流病合并腹股沟疝患者的围手术期处理及其安全性。方法:回顾分析2012年10月至2015年10月收治的13例食管裂孔疝致胃食管反流病合并腹股沟疝(15侧)患者的临床资料。均行腹腔镜手术,其中9例行腹腔镜全腹膜外疝修补术,4例行经腹腹膜前疝修补术;9例行单纯食管裂孔疝缝合,2例采用生物补片修补,1例采用强生PHY补片修补,1例行单纯胃底固定。抗反流术式包括Nissen胃底折叠术6例,Dor胃底折叠术4例,Toupet胃底折叠术2例。回顾总结患者的围手术期处理措施。结果:本组患者均无围手术期死亡,术后无严重并发症发生,其中术后切口感染1例,阴囊水肿1例,予以换药、理疗后好转。2例患者术后出现进食哽噎,嘱其少量多餐、细嚼慢咽,1个月后症状消失。合并贫血患者术后血红蛋白恢复至95 g/L,术后中位随访时间为10个月,无复发病例。结论:食管裂孔疝致胃食管反流病合并腹股沟疝患者病情较复杂,手术风险大,难度高,但只要做好充分的术前准备,采用恰当的手术方式,术中谨慎、细致操作,针对性的处理术后出现的各种问题,手术是安全、可行的。

Objective：To investigate the perioperative management and safety of the patients who suffered from hiatal hernia combined with gastroesophageal reflux disease and inguinal hernia. Methods：The clinical data of 13 patients who suffered from hiatal hernia combined with gastroesophageal reflux disease and inguinal hernia in Xinjiang Uygur Autonomous Region People＇s Hospital from Oct. 2012 to Oct. 2015 were retrospectively analyzed. All of them underwent laparoscopic minimally invasive surgery,9 of them received laparoscopic totally extraperitoneal prosthesis ,4 patients underwent transabdominal preperitoneal repair. There were 9 cases of simple hiatal hernia suture ,2 cases used biological patch repair, 1 case used Johnson PHY patch repair and 1 case underwent simple fixation of stomach fundus. In anti-reflux surgery there were 6 cases of Nissen fundoplication,4 cases of Dot fundoplication and 2 cases of Toupet fundoplication. The perioperative treatment measures were retrospectively analyzed. Results： No perioperative death and no serious post- operative complications occurred. There was 1 case of postoperative wound infection and 1 case of scrotal edema, both of them recovered after dressing change and physiotherapy. 2 patients complained postoperative choking when eating, which disappeared after 1 month of small meals and slow chew. The hemoglobin in the patient with preoperative anemia recovered to 95g/L after the surgery. None of them recurred after 10 months＇ follow-up. Conclusions： The risk of surgery is high and the operation would be difficult with the complex condition in hiatal hernia combined with gastroesophageal reflux disease and inguinal hernia. However, it is still safe and feasible with adequate preoperative preparation, appropriate surgical methods, careful and meticulous operation and targeted treatment of postoperative various problems.