聚丙烯补片在腹腔镜下食管裂孔疝修补联合胃底折叠术的临床应用

Clinical application of laparoscopic repair of esophageal hiatal hernia with polypropylene mesh

目的探讨聚丙烯补片在腹腔镜下食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效。方法回顾性分析新疆维吾尔自治区人民医院2013年5月至2015年3月,住院治疗并使用聚丙烯补片(强生PHY补片)行腹腔镜下食管裂孔疝修补术联合胃底折叠术的38例患者临床资料,总结上述患者术前、术后6个月24 h食管p H监测、高分辨率食管测压、胃食管反流病调查问卷(GERD-Q)量表评分及术后并发症特点。结果全部患者手术顺利无中转术式等情况,其中Nissen术式27例,Toupet术式8例,Dor术式3例。术后患者反流症状均较术前明显改善,术后反流时间、反流次数、DeMeester评分、GERD-Q量表评分等较术前明显降低,差异有统计学意义(P<0.05),术后出现吞咽困难3例,腹部胀气2例,随访过程中无严重并发症发生,无复发。结论使用聚丙烯补片行腔镜食管裂孔疝修补联合胃底折叠术是治疗食管裂孔疝的有效方法,具有微创、恢复快、并发症少、复发率低等特点。

Objective To evaluate the clinical efficacy of polypropylene patch in laparoscopic hiatal hernia repair in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease. Methods A total of 38 cases of laparoscopic repair of esophageal hiatal hernia in our hospital from May 2013 to March 2015 were with Johnson PHY patch, Analyzed the 24 hours esophageal pH monitoring, high resolution manometry, gastroesophageal reflux disease questionnaire （ GERDQ） score and postoperative complications of patients preoperative and after 6 months. Results All patients were operated successfully, and 27 cases of Nissen fundoplication,8 cases were taken Toupet fundoplication,73 cases were taken Dor fundoplication,there were no serious complications occurred after operation. Preoperative reflux time, the counter flow frequency, DeMeester score, GERDQ were significantly decreased after operation, and the difference was statistically significant （ P 〈 0. 05 ） . Conclusion The use of polypropylene mesh with Endoscopic esophageal hiatal hernia repair and fundoplication is an effective method for the treatment of hiatal hernia,it has the advantages of minimal invasion,fast recovery,less complications and low recurrence rate.