腹腔镜Toupet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

Clinical efficacy of laparoscopic Toupet fundus folding in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease

目的探讨腹腔镜Toupet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。方法选取2012年1月至2018年6月,吉林大学第二医院就诊的80例食管裂孔疝合并胃食管反流病患者为研究对象。依据患者具体状况行不同类型的疝修补术,所有患者均行腹腔镜Toupet胃底折叠术。于术后统计患者手术效果及反流情况,观察手术前后食管压变化。结果与术前相比,术后6个月患者反流时间显著缩短、反流次数与长反流次数显著减少、酸反流时间百分比显著下降,差异均有统计学意义(P<0.05)。与术前相比,术后6个月患者DeMeester及GERDQ评分均显著下降,差异均有统计学意义(P<0.05)。与术前比较,术后6个月患者LES压力、残余压均显著升高,松弛率显著下降,差异均有统计学意义(P<0.05)。结论腹腔镜Toupet胃底折叠术治疗食管裂孔疝合并胃食管反流病可有效增加食管压力,抑制患者反流症状,疗效良好,值得推广应用。

Objective To explore the clinical efficacy of laparoscopic Toupet fundus folding in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease. Methods The clinical data of 80 patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease treated in Second Hospital of Jilin University between January 2012 and June 2018 were analyzed. Different types of herniorrhaphy were performed according to the specific conditions of the patients. All patients underwent laparoscopic Toupet fundus folding. The results of operation and reflux condition were counted after operation, and the changes of esophageal pressure before and after operation were observed. Results Compared with conditions before operation, the reflux time was significantly shortened, the times of reflux and the times of long reflux significantly reduced, and the percentage of acid reflux time significantly decreased 6 months after operation (P<0.05). Compared with conditions before operation, the scores of DeMeester and GERDQ decreased significantly 6 months after operation (P<0.05). Compared with conditions before operation, low esophageal sphincter (LES) pressure and residual pressure significantly increased and the relaxation rate significantly decreased 6 months after operation (P<0.05). Conclusion Laparoscopic Touset fundus folding in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease can effectively increase esophageal pressure and restrain the reflux symptoms of patients, which is worth popularized.