腹腔镜食管裂孔疝修补术联合胃底折叠术联合胆囊切除术的疗效分析

Analysis the efficacy of laparoscopic hiatal hernia repair and fundoplication and cholecystectomy treatment of hiatal hernia combined with gastroesophageal reflux disease and gallstone

目的探讨腹腔镜食管裂孔疝修补术联合胃底折叠术联合胆囊切除术治疗食管裂孔疝合并胃食管反流病合并胆囊结石患者的临床疗效。方法回顾性分析新疆维吾尔自治区人民医院2012年8月至2016年8月,收治的27例行腹腔镜食管裂孔疝修补术联合胃底折叠术联合胆囊切除术治疗食管裂孔疝合并胃食管反流病合并胆囊结石患者的临床资料,其中单纯食管裂孔疝修补患者22例,生物补片修补患者2例,强生PHY补片修补患者1例,巴德补片修补患者1例,泰科食管裂孔疝专用防粘连补片修补患者1例。统计上述患者术前及术后6个月的24 h食管p H、食管测压、GERD-Q量表评分及术后并发症等,回顾性分析腹腔镜食管裂孔疝修补术联合胃底折叠术联合胆囊切除术治疗食管裂孔疝合并胃食管反流病合并胆囊结石的临床疗效。结果本组患者无围手术期死亡,术后无严重并发症发生,术后患者反流症状均较术前明显改善,反流时间(1.40±2.10)h、反流次数(29.83±19.71)次、酸反流时间百分比(6.47±8.79)%、及De Meester评分(7.28±7.38)分、GERDQ量表评分(7.18±1.33)分较术前分别为(2.04±1.91)h、(120.40±82.72)次、(9.90±9.27)%、(28.23±42.16)分、(10.91±2.02)分明显降低,差异有统计学意义(P<0.05);术后LES压力中的静息呼吸最小值为(7.24±6.86)mm Hg,静息呼吸平均值为(12.91±6.89)mm Hg,较术前分别为(0.70±6.15)mm Hg、(7.33±7.72)mm Hg明显提高,残余压平均值为(8.16±3.82)mm Hg,最大值为(16.10±12.05)mm Hg,较术前分别为(4.36±4.77)mm Hg、(7.49±5.15)mm Hg明显提高,差异有统计学意义(P<0.05);术后松弛率(58.50±25.47)%]较术前[(62.27±27.55)%明显降低,但术后无效吞咽百分比(11.25±21.04)%较术前(6.36±10.26)%略有增加,差异无统计学意义(P>0.05)。随访中位数10个月,随访过程中无复发。结论腹腔镜食管裂孔疝修补术联合胃底折叠术联合胆囊切除术可有效抑制反流症状,提高LES压力,解决患者病痛,疗效确切,值得临床推广。

Objective To researchthe efficacy of laparoscopic hiatal hernia repair and fundoplication and cholecystectomy treatment of hiatal hernia combined with gastroesophageal reflux disease and gallstone. Methods 27 patients＇ information ofhiatal hernia combined with gastroesophageal reflux disease and gallstone that underwentlaparoscopic hiatal hernia repair and fundoplication and cholecystectomy in Xinjiang Uygur Autonomous Region Peopled Hospital from August 2012 to August 2016. 22 cases were adopted pure hiatal hernia suture,2 cases used biological patch repair,! case used Johnson PHY patch repair,1 case used Bade patch repair, 1 case used Tyco hiatal hernia dedicated anti-blocking patch repair. Analyzed and detected24 hours esophageal pH, esophageal manometry, GERD Q score and postoperative complications before surgery and 6 months postoperativeof these patients,. Retrospective analysis of the clinical efficacy of laparoscopic hiatal hernia repair and fundoplication and cholecystectomy treatment of hiatal hernia combined with gastroesophageal reflux disease and gallstone. Results There was no perioperative deaths and serious complications during perioperative. The reflux symptoms were significantly improved postoperative. In reflux t ime（1.40±2. 10）,the number of ref lux（29.83 ±19.71）,acid reflux time percentage（6.47 ±8.79）and DeMeester score（ 7. 28 ± 7. 38 ） were lower than the preopemtive （ 2. 04 ± 1. 91 ）,（ 120. 40 ± 82. 72 ）, （9. 90 ± 9. 27） , （28. 23 ±42. 16） , respectively, GERD Q scale score（ 7. 18 ± 1. 33 ） was significantly lower than preoperative（ 10. 91 ± 2. 02 ）,the difference was statistically significant^ P 〈 0. 05 ） . LES pressure with minimum resting breathing was （ 7. 24 ± 6. 86 ）,mean resting breathing was （ 12. 91 ± 6. 89 ）,which were significantly increased than preoperative （ 0. 70 ± 6. 15 ）,（ 97. 33 ± 7. 72 ） , respectively, residual pressure with average was （ 8. 16 ± 3. 82 ）,maximum was （ 16. 10 土 12. 05 ） ,weresignificantly increased than preoperative（4. 36 ±4. 77）, （7. 49 ±5. 1 5 ）, respectively, relaxation rate（58. 50 ±25. 47） % was significantly reduced than preoperative （62.27 ±27.55）%,but swallowing invalid （11.25 ±21.04）was increased than preoperative （ 6. 36 ± 10. 26）,the difference was no significant^ P 〉 0. 05 ）. The median follow-up time waslO months, with no recurrence during follow-up. Conclusion Laparoscopic hiatal hernia repair and fundoplication can effectively inhibit reflux symptoms, increase LES pressure, which worthy of promotion, in patients with pain resolved and effective, worthy of promotion.