腹腔镜与开腹手术治疗3月龄以内婴儿先天性食管裂孔疝的对比研究

A comparative study of laparoscopy versus open surgery for congenital hiatal hernia in infants aged under 3 months

目的对比腹腔镜与开腹手术治疗3月龄以内婴儿先天性食管裂孔疝的疗效。方法回顾性分析2008年1月至2017年6月于湖南省儿童医院接受手术治疗的61例3月龄以内先天性食管裂孔疝患儿的临床资料,其中腹腔镜组31例(行腹腔镜食管裂孔修补+Nissen手术),开腹组30例(行开腹食管裂孔修补+Nissen手术)。比较两组患儿手术时间、术后开奶时间、住院时间、术后并发症等情况。结果腹腔镜组比开腹组手术时间更长[(141. 0±31. 0) min vs.(121. 2±26. 4) min,P=0. 011],术后开奶时间(中位数:2. 0 d vs. 4. 0 d,P=0. 000)和术后住院时间(中位数:7. 0 d vs. 10. 5 d,P=0. 000)均比开腹组更短。腹腔镜组术后解剖复发3例(9. 7%),食管狭窄1例(3. 2%),再手术2例(6. 5%);开腹组术后出现解剖复发2例(6. 7%),切口裂开5例(16. 7%),粘连性肠梗阻1例(3. 3%),再手术2例(6. 7%)。腹腔镜组术后切口裂开发生率低于开腹组,差异有统计学意义(P <0. 05);两组术后解剖复发、食管狭窄、粘连性肠梗阻和再手术的发生率比较均无统计学意义(P>0. 05)。61例术后平均随访38个月(6～60个月),患儿呕吐症状消失,生长发育良好。结论腹腔镜食管裂孔修补+Nissen手术治疗婴儿先天性食管裂孔疝安全、有效,较开腹手术具有创伤小、术后恢复快、并发症少等优点。

Objective To compare the efficacies of laparoscopy versus open surgery for congenital hiatal hernia in infants aged under 3 months.Methods Retrospective analysis was performed for the clinical data of 61 surgical infants with congenital hiatal hernia aged under 3 months from January 2008 to June 2017.Laparoscopic esophageal hiatus repair plus Nissen fundoplication(laparoscopic group,n=31)and open esophageal hiatus repair plus Nissen fundoplication(open group,n=30)were performed.Operative duration,postoperative time to milk feeding,length of postoperative hospital stay and postoperative complications were compared between two groups.Results The laparoscopic group had a longer operation time than the open group[(141.0±31.0)min vs.(121.2±26.4)min,P=0.011],shorter median postoperative time to milk feeding(2.0 vs.4.0 days,P=0.000)and shorter median length of postoperative hospital stay(7.0 vs.10.5 days,P=0.000).There were significant inter-group differences.In laparoscopic group,there were anastomotic recurrence(n=3,9.7%),esophageal stenosis(n=1,3.2%)and reoperation(n=2,6.5%).In open group,there were anastomotic recurrence(n=2,6.7%),wound dehiscence(n=5,16.7%),adhesive intestinal obstruction(n=1,3.3%)and reoperation(n=2,6.7%).The incidence of wound dehiscence was lower in laparoscopy group than that in open group and the differences were statistically significant(P<0.05).Significant inter-group differences existed in anatomic recurrence,esophageal stenosis,adhesive intestinal obstruction and reoperation(P >0.05).The median postoperative follow-up period was 38(6-60)months.All developed well and there was no occurrence of vomiting.Conclusion Both safe and effective for congenital hiatal hernia in infants,laparoscopic esophageal hiatus repair and Nissen fundoplication offer many advantages of less trauma,faster postoperative recovery and fewer complications as compared with open surgery.