单中心腹腔镜治疗小儿食管裂孔疝的中远期疗效观察

The observation of medium and long term effect of single center laparoscopic treatment of children hiatal hernia

目的总结分析腹腔镜治疗小儿食管裂孔疝的中远期疗效.方法2014年1月~2018年12月连续49例腹腔镜治疗小儿食管裂孔疝,年龄2~85个月,中位数18.5个月(P25~P75,12.3~28.8个月).滑动型疝1例,食管旁疝17例,混合型疝31例.采取腹腔镜四孔法行食管裂孔疝修补+抗反流手术.抗反流手术采取Nissen折叠9例、Dor折叠15例、Thal折叠25例.记录手术时间、术中出血量、胃肠功能恢复时间、术后住院时间、术后并发症发生情况,并随访观察术后恢复情况.结果中转开腹手术3例,余46例均顺利行腹腔镜手术.术后随访27~83个月,中位数64.0个月(P25~P75,47.3~73.8个月),术后并发食管狭窄1例,行食管狭窄球囊扩张后明显缓解;术后胃食管反流9例,药物止酸治疗5例;疝复发再次手术1例.结论绝大部分小儿食管裂孔疝可经腹腔镜治疗,手术安全可行,术后并发症发生率和复发率低,中远期治疗效果满意.

Objective To summarize and analyze the long-term efficacy of laparoscopic treatment of children with hiatal hernia.Methods The data of 49 consecutive cases of pediatric hiatal hernia treated by laparoscopy in our hospital from January 2014 to December 2018 were retrospectively analyzed,with an age range of 2 to 85 months and a median of 18.5 months(P25 to P75,12.3 to 28.8 months).There were 1 cases of sliding hernia,17 cases of paraesophageal hernia and 31 cases of mixed hernia.Laparoscopic hiatal hernia repair and antireflux surgery were performed using a 4-well method.The operative time,intraoperative blood loss,recovery time of gastrointestinal function,postoperative hospital stay and postoperative complications were recorded,and the postoperative recovery was observed.Results 3 cases were converted to open surgery,and the remaining 46 cases underwent laparoscopic surgery successfully.Postoperative follow-up ranged from 27 to 83 months,with a median of 64.0 months(P25 to P75,47.3 to 73.8 months).One patient with esophageal stenosis was significantly relieved after balloon dilation of esophageal stenosis.9 cases of gastroesophageal reflux,5 cases of drug antiacid treatment;One case of hiatal hernia recurred and was re-operated.Conclusion The majority of children's hiatal hernia can be treated by laparoscopy,the operation is safe and feasible,the incidence of postoperative complications and recurrence rate is low,and the long-term treatment effect is satisfactory.