腹腔镜食管裂孔疝修补术不同手术方式的临床疗效及预后分析

Clinical efficacy and prognosis of different laparoscopic hiatal hernia repair

目的比较不同手术方式在腹腔镜食管裂孔疝修补术中的有效性及复发率的差异。方法回顾性分析2016年1月至2022年3月于兰州大学第一医院、甘肃省人民医院及甘肃省中医院行腹腔镜食管裂孔疝修补联合胃底折叠术治疗的90例食管裂孔疝患者的临床资料,其中26例未使用补片,29例使用合成补片,35例使用生物补片。对三组患者进行术后随访,比较三组患者手术时间、术中出血量、手术费用及术后并发症发生率、复发率以及满意度等指标。结果 90例均顺利完成手术,无中转开腹病例。三组患者手术时间、术中出血量、术后住院天数差异均无统计学意义(均P>0.05),未使用补片组住院费用与合成补片和生物补片组相比更具有经济学优势,差异均有统计学意义(P<0.05)。87例患者获得长期随访,随访率为96.7%(87/90),中位随访时间为44个月。术后并发症(腹泻、吞咽困难、腹胀、胸痛)发生率、症状复发率(反酸、烧心)以及患者满意度,三组间差异无统计学意义(P>0.05)。结论在食管裂孔疝修补术中,应根据术中具体情况,谨慎选择补片。

Objective To compare the effectiveness and recurrence rate of different types of mesh or without mesh in laparoscopic hiatal hernia repair.Methods From Jan 2016 to Mar 2022 at the three hospital 90 patients with hiatal hernia,including 26 cases without mesh,29 cases using synthetic mesh,and 35 cases using biological mesh underwent laparoscopic hiatal hernia repair.Results The surgical procedures was successful in all the 90 cases without conversion to open surgeny.There were no statistically significant differences in operative time,intraoperative blood loss and postoperative hospital stay among the three groups(P>0.05),and there were statistically significant differences in hospital cost between the group without mesh and synthetic mesh and biological mesh(P<0.05).Long-term follow-up was achieved in 87 patients,with a follow-up rate of 96.7%(87/90),and a median follow-up time of 44 months.There were no significant differences in the incidence of postoperative complications(diarrhea,dysphagia,abdominal distension,chest pain),recurrence rate of symptoms(acid reflux,heartburn)and patient satisfaction among the three groups(P>0.05).Conclusion In laparoscopic hiatal hernia repair,the mesh should be carefully selected according to the specific intraoperative situation for a satisfactory clinical efficacy.