目的 探讨基于识别关键解剖的腹腔镜食管裂孔旁疝（PEH）修补术的学习曲线特征和临床疗效。方法 回顾性分析2021年1月至2025年12月中国科学技术大学附属第一医院疝及肥胖外科收治的行腹腔镜疝修补术联合胃底折叠术的83例PEH病人的临床资料。观察指标包括术后复发率、胃食管反流病（GERD）症状缓解率、术后并发症发生率。采用累积和（CUSUM）分析法绘制手术学习曲线，比较不同学习阶段的手术时间、复发率、并发症发生率和术后GERD问卷量表（GERD-Q）评分改善情况。结果 随访22（1~60）个月，无影像学复发。Gerd-Q评分由术前的12（6~18）分降至6（3~14）分（Z=-10.158，P<0.001），GERD症状缓解率为94.0%（78/83），质子泵抑制剂停药率为97.6%（81/83）。83例病人均顺利完成手术，术中并发症发生率为6.0%（5/83），均为右侧胸膜破裂。术中识别出心下囊病人术中并发症发生率显著低于未识别者（0 vs. 29.4%，P<0.001）。术后并发症方面，1例（1.2%）病人因Nissen折叠瓣过紧行二次手术，术后吞咽困难发生率为10.8%（9/83），术后反流发生率为4.8%（4/83）；Nissen与Dor胃底折叠术后吞咽困难和反流发生率差异均无统计学意义（均P>0.05）。学习曲线拐点为31例，据此将病人分为学习期（31例）与熟练期（52例），熟练期术中并发症发生率显著低于学习期（1.9% vs. 16.1%，P=0.025），而两组术后GERD-Q评分、术后吞咽困难与反流发生率差异均无统计学意义（P>0.05）。结论 在腹腔镜PEH修补术的学习曲线期间，需要更深入理解食管胃结合部外科解剖和功能，有助于降低并发症发生率和复发率、提高GERD缓解率。

Objective To explore the learning curve characteristics and clinical efficacy of laparoscopic paraesophageal hernia repair based on key anatomical principles. Methods A retrospective analysis was conducted on the clinical data of 83 patients who underwent laparoscopic mesh repair of paraesophageal hernia combined with fundoplication at the Department of Hernia and Obesity Surgery, The First Affiliated Hospital of University of Science and Technology of China, between January 2021 and December 2025. The observed outcomes included postoperative recurrence rate, GERD remission rate, and incidence of postoperative complications. The cumulative sum (CUSUM) analysis method was used to plot the learning curve of paraesophageal hernia repair, and comparisons were made across different learning phases in terms of operative time, recurrence rate, complication rate, and improvement in postoperative GERD-Q scores. Results Follow-up was 22 (1-60) months, with no imaging-confirmed recurrence. The GERD-Q score decreased from 12 (6-18) preoperatively to 6 (3-14) postoperatively (Z=-10.158, P<0.001). The GERD remission rate was 94.0% (78/83), and the rate of proton pump inhibitor discontinuation was 97.6% (81/83). All 83 patients successfully underwent the surgery, with an intraoperative complication rate of 6.0% (5/83), all of which were right-sided pleural tears. The intraoperative complication rate was significantly lower in the group with identification of the infracardiac bursa compared to the group without identification (0 vs. 29.4%, P<0.001). Regarding postoperative complications, one patient (1.2%) underwent reoperation due to excessive tightness of the Nissen fundoplication. The incidence of postoperative dysphagia was 10.8% (9/83), with no statistically significant difference between the Nissen group (13.6%) and the Dor group (4.2%). The incidence of postoperative reflux was 4.8% (4/83), also showing no statistically significant difference between the two groups (both P>0.05). The CUSUM learning curve analysis identified an inflection point in 31 cases, based on which patients were divided into the learning phase (31 cases) and the proficiency phase (52 cases). The intraoperative complication rate was significantly lower in the proficiency phase than in the learning phase (1.9% vs. 16.1%, P=0.025), while there were no statistically significant differences between the two phases in terms of postoperative GERD-Q scores, dysphagia, or reflux incidence (P>0.05). Conclusion During the learning curve of laparoscopic paraesophageal hernia repair, a deeper understanding of the surgical anatomy and function of the gastroesophageal junction is required, which can achieve advantages such as a low recurrence rate, a high remission rate of GERD symptoms, and few complications.