腹腔镜手术治疗新生儿食管裂孔疝11例报告

Laparoscopic Repair for Neonatal Esophageal Hiatal Hernia:a Clinical Analysis of 11 Cases

目的探讨腹腔镜手术治疗新生儿食管裂孔疝(产前超声诊断)的临床效果。方法回顾性分析2015年5月~2021年1月我科11例新生儿(男7例,女4例)食管裂孔疝(产前超声诊断)的临床资料。手术时患儿年龄2~94 d(中位数4 d)。体重(2.82±0.51)kg。出生后胸部CT、上消化道造影明确诊断,采用腹腔镜下四孔法行食管裂孔疝修补、胃底折叠术,其中9例Nissen术,2例Thal术。结果11例均在腹腔镜下完成手术,无中转开腹手术。9例Nissen术,手术时间(173.0±43.8)min;2例Thal术的手术时间分别为184、206 min。术后恢复进食时间(2.5±1.2)d。住院时间(14.1±4.1)d。11例患儿随访7~74个月,中位随访28个月,术后食管裂孔疝无复发,身高、体重与同龄儿无明显差别,无明显呕吐,无纳奶呛咳。结论新生儿期行腹腔镜手术治疗产前诊断的食管裂孔疝是安全可靠的。

Objective To explore the clinical efficacy of laparoscopic esophageal hernia repair for neonatal esophageal hiatal hernia by ultrasonographic diagnosed prenatally.Methods From May 2015 to January 2021,a total of 11 neonates(7 males and 4 females)with esophageal hiatal hernia diagnosed prenatally were treated with laparoscopic hiatal hernia repair.The age at operation was 2-94 days old,with a median of 4 days old.The body weight was(2.82±0.51)kg.Preoperative chest CT and upper gastrointestinal radiography were performed to confirm the diagnosis of esophageal hiatal hernia.All the 11 children underwent laparoscopic four-hole repair of esophageal hiatal hernia and gastric fundus folding,including 9 cases of Nissen procedure and 2 cases of Thal procedure.Results All the operations were performed under laparoscopy without conversion to laparotomy.The operation time of 9 cases of Nissen procedure was(173.0±43.8)min.The operation time of Thal procedure was 184 min and 206 min,respectively.The time to postoperative diet was(2.5±1.2)days.The hospital stay was(14.1±4.1)days.The 11 neonates were followed up for 7-74 months,with a median of 28 months.No postoperative recurrence of esophageal hiatal hernia occurred.There was no significant difference in height and weight between children of the same age.No obvious vomiting or choking with milk was found.Conclusion It is safe and reliable to perform laparoscopic surgery in neonatal period for the treatment of esophageal hiatal hernia diagnosed prenatally.