中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (04): 456-460.DOI: 10.19538/j.cjps.issn1005-2208.2024.04.18

• 论著 • 上一篇    下一篇

食管裂孔疝复发原因分析及处理经验（附12例报告）

关    磊，赵敏娴，聂玉胜，杨慧琪   

  1. 首都医科大学附属北京朝阳医院疝和腹壁外科，北京 100043
  • 出版日期:2024-04-01 发布日期:2024-05-07

  • Online:2024-04-01 Published:2024-05-07

摘要： 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。

关键词: 食管裂孔疝, 复发, 腹腔镜, 补片

Abstract: Pathogeny analysis and management experience of recurrent hiatal hernia: report of 12 cases        GUAN Lei, ZHAO Min-xian, NIE Yu-sheng, et al. Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Bejing 100043, China
Corresponding author: YANG Hui-qi, E-mail: yang.huiqi@qq.com
Abstract    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. Type Ⅲ hernia 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.

Key words: hiatal hernia, reccurence, laparoscope, mesh