经腹腔镜手术治疗食管裂孔疝的疗效观察:附21例报告

Laparoscopic repair of hiatus hernia for curativeobservation about 21 cases

目的回顾在地州级医院进行腹腔镜下食管裂孔疝修补术＋胃底折叠术的疗效和安全性。方法对2013年5月至2015年3月在喀什地区第一人民医院收住的21例因食管裂孔疝所导致的胃食管反流病患者经腹腔镜行食管裂孔疝修补术＋胃底折叠术,其中13例做胃底270°部分折叠术（Toupet术）,8例做胃底360°胃底折叠术（Nissen术）。6例应用补片修补疝缺口,15例采用2-0不可吸收线缝合膈肌脚。结果 21例行经腹腔镜食管裂孔疝修补术的患者手术效果均良好。手术时间45~180 min,平均手术时间118 min,出血量30~70 ml;术后24~48 h流质饮食,术后5例出现吞咽困难、进食时胸部及上腹部不适感等,经过术后饮食教育症状均得到缓解,1例出现反酸症状缓解不明显,建议口服止酸和促进胃蠕动的药物后症状有所缓解,术后测压发现此患者食管蠕动功能较差故导致反酸症状缓解不明显;术后平均住院6.5 d。结论 20例患者的反酸症状均在24~48 h内缓解,术后停用抗酸药物,经腹腔镜食管裂孔疝修补术＋胃底折叠术具有疗效明确、安全和创伤小等优点。严格把握手术适应证,合理选择胃底折叠术式在地州级医院具有进一步推广应用的价值。

Objective To investigate the efficacy and safety of laparoseopic repair of paraesophageal hernia and ganstroesophageal reflux disease. Methods 21 patients underwent laparoscopic repair of paraesophageal hernia, including 13 cases having laparoscopic Toupet fundoplication And 8 cases having laparoscopic Nissen fundoplication. Results Laparoscopicrepair of paraesophageal Hernia and Laparoscopic fundoplication was completed successfully in all 21 patients. The average operation time 118min and the blood loss Was between 30~70 ml. Postoperative oral feedings were resumed after 24~48 h of surgery. The median postoperative hospital stay Was 6. 5 days. Conclusion Laparoscopic repair of paraesophageal hernia and Laparoscopic fundoplication is an effective and safe surgcal procedure of minimal invasion for Paraesophageal hernia.