食管裂孔疝复发原因分析及处理经验(附12例报告)

Pathogeny analysis and management experience of recurrent hiatal hernia:report of 12 cases

目的 探讨食管裂孔疝术后复发原因并总结处理经验。方法 回顾性分析2020年6月至2023年11月首都医科大学附属北京朝阳医院疝和腹壁外科收治的12例复发性食管裂孔疝病人的临床资料。分析病人的既往及本次手术情况、复发分型、术后随访情况。结果 12例复发性食管裂孔疝病人中3例为开胸修补术后复发,9例为腹腔镜修补术后复发。均择期行腹腔镜食管裂孔疝修补术,其中1例中转开放手术,术中均再次放置合成补片并行部分胃底折叠术。8例(66.7%)病人前次手术放置补片。12例复发病人中8例(66.7%)为食管前复发,4例(33.3%)为食管后复发;6例为Ⅲ型食管裂孔疝。手术时间为122.5(80~265)min,术中出血20.0(5~300)mL。术后住院时间为5.5(4~8)d。围手术期无器官损伤及功能障碍、肺不张、肺部感染等并发症。随访2~42个月,无补片感染、补片侵蚀、长期慢性疼痛、肠梗阻、复发等严重并发症,术后症状改善率为91.7%,术后满意度为91.7%。结论食管裂孔疝复发病例中,以食管前复发多见;腹腔镜下使用补片修补复发性食管裂孔疝安全、可行,但须严格把握手术指征,充分评估风险。

Objective To evaluate the pathogeny and management experience of recurrent hiatal hernia.Methods A retrospective study was performed to analyze the clinical data of cases of recurrent hiatal hernia undergoing laparoscopic surgery in Beijing Chao-Yang Hospital of June 2020 to November 2023.The general dates,previous and this operation situation,recurrence type,and postoperative follow-up were analyzed.Results All the cases were diagnosed definitely and completed selective laparoscopic operation including 3 cases with recurrence after thoracotomy repair surgery,and 9 cases with recurrence after laparoscopic surgery.All the cases were placed non-absorbable mesh again and partial fundoplication.Most of the operations were finished successfully under laparoscope with one open conversion case,all the cases with intraoperative mesh placement,8 cases(66.7%)with pre-esophageal recurrence,and 4 cases(33.3%)with retro-esophageal recurrence.TypeⅢhernia accounted for the largest proportion(50%).Average operating time 122.5(80-265)min,average blood loss 20.0(5-300)mL,average postoperative hospital stays 5.5(4-8)d.No case was associated with perioperative complications including organ injury or dysfunction,atelectasis,or pneumonia.All the cases were followed up for 2 to 42 months,and no case was reported with severe complications such as mesh infection,long-term chronic pain,intestinal obstruction,and hernia recurrence.Postoperative symptom improvement rate(91.7%),postoperative satisfaction rate(91.7%).Conclusion Anterior recurrence accounted for the largest proportion of hiatal hernia recurrence.Laparoscopic surgery of recurrent hiatal hernia is a safe,feasible,and effective method with satisfactory results.