腹腔镜完全左侧手术入路在食管裂孔疝合并胃食管反流病患者中的应用研究

Application research of laparoscopic total left-side surgical approach in patients with hiatal hernia and gastroesophageal reflux disease

目的探讨腹腔镜完全左侧手术入路(TLSA)在食管裂孔疝合并胃食管反流病患者中的应用,评估该术式的近期疗效和安全性。方法回顾性分析2019年6至9月首都医科大学附属北京友谊医院普外分中心施行TLSA治疗的5例患者临床资料,对手术相关指标、并发症和生活质量评分进行分析。结果5例患者平均手术时间114 min,所有患者术后4 d内胃肠功能恢复正常,平均住院时间3.8 d,术后均未出现感染、出血、食管穿孔和死亡等并发症。术后6个月复查胃镜可见胃食管阀瓣良好,平均Gerd-Q评分由术前12.4分下降至6.2分,平均总体酸暴露时间由3.48%下降至0.38%,EORTC QLQ-STO52评分提示术后吞咽困难、腹胀等情况,随手术时间的延长,症状逐渐减轻或消失。结论腹腔镜TLSA具有术野广阔、手术时间短、操作简单等优势,适用于高龄或合并较多基础疾病的患者,具有较好的近期疗效和安全性。

Objective To investigate the application of laparoscopic total left-side surgical approach(TLSA)in patients with hiatal hernia and gastroesophageal reflux disease,and to evaluate the short-term efficacy and safety of this surgical approach.Methods To retrospectively analyze the clinical data of 5 patients who underwent TLSA from June 2019 to September 2019 in Beijing Friendship Hospital and analyze the operation-related indicators,complications and quality of life score.Results The median total operative time was 114 minutes,the patients'gastrointestinal function was recovery within 4 days and the average hospital stay was 3.8 days.No complications such as infection,bleeding,esophagus perforation and death occurred in the 5 patients.At six months postoperatively,gastroscopy reexamination showed their gastroesophageal flap valve are well established,the total score of Gerd-Q was 12.4 vs.6.2,total esophageal acid exposure time was 3.48%vs.0.38%.The incident of the dysphagia and flatulence were estimated by the EORTC QLQ-STO52 questionnaire decline with the time after the surgery.Conclusion TLSA has the advantages of broad surgical field,short surgical time and simple operation,especially suitable for elderly patients and patients with more underlying disease,and it has good short-term efficacy and safety.