不同手术方法治疗小儿食管裂孔疝的临床疗效观察

Clinical observation of different surgical methods in the treatment of children with esophageal hiatal hernia

目的:观察不同手术方法治疗小儿食管裂孔疝的临床疗效。方法:选择2008年8月至2018年8月收治的30例食管裂孔疝患儿,其中15例行开腹食管裂孔疝修补术+胃底折叠术(开腹组),15例行腹腔镜下食管裂孔疝修补术+胃底折叠术(腹腔镜组)。对比分析两组手术时间、术中出血量、肠道功能恢复时间、术后住院时间、并发症等指标,分别于术前及术后第1天、第5天测定C反应蛋白。结果:患儿均痊愈出院。腹腔镜组手术时间、出血量、肠功能恢复时间、住院时间均优于开腹组,差异有统计学意义;两组并发症发生率差异无统计学意义;术后两组C反应蛋白水平均升高,但腹腔镜组较低,与开腹组相比差异有统计学意义。结论:腹腔镜手术治疗小儿食管裂孔疝对机体打击小,是安全、可行、创伤小、康复快的术式。

Objective: To observe the clinical efficacy of different methods in the treatment of children with esophageal hiatus hernia. Methods: Thirty children with esophageal hiatus hernia were enrolled from Aug.2008 to Aug.2018.15 children underwent open esophageal hiatus hernia repair and fundoplication (open group),and 15 underwent laparoscopic esophageal hiatus hernia repair and fundoplication (laparoscopic group).The operative time,intraoperative blood loss,intestinal function recovery time,postoperative hospitalization time and complications were compared between the two groups.The CRP was measured before operation and on the 1st and 5th day after surgery. Results: All children were cured and discharged.The operation time,intraoperative blood loss,intestinal function recovery time and hospitalization time in the laparoscopic group were better than those in the open group,the difference was statistically significant.There was no significant difference in the incidence of complications between the two groups.The CRP levels in the two groups increased after operation,but the laparoscopic group was lower than the open group with statistically significant difference. Conclusions: For children with esophageal hiatus hernia,laparoscopic surgery is safe,feasible and mini-invasive,has advantages of quick recovery and little influence on patients.