中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (04): 461-464.DOI: 10.19538/j.cjps.issn1005-2208.2025.04.14

• 论著 • 上一篇    下一篇

腹腔镜胃部手术联合食管裂孔疝修补术安全性及可行性分析

刘    利，王    骥，马红钦，杜羽升，赵文星   

  1. 徐州医科大学附属医院普通外科，江苏徐州 221002
  • 出版日期:2025-04-01 发布日期:2025-04-30

  • Online:2025-04-01 Published:2025-04-30

摘要： 目的    探讨腹腔镜胃部手术联合食管裂孔疝（HH）修补术的安全性和可行性。方法    回顾性分析2014年12月至2023年11月徐州医科大学附属医院普外科收治的37例行腹腔镜胃部手术联合HH修补术病人，以及2023年1～12月收治的仅行腹腔镜远端胃切除术的28例病人的围手术期资料和随访资料。总结联合手术病人的术中及术后情况，并对比腹腔镜远端胃切除术联合HH修补术病人（联合远端胃切除组）与仅行腹腔镜远端胃切除术病人（单纯远端胃切除组）的临床资料。结果    术前合并胃食管反流（GERD）的病人术后GERD缓解率为90.9%，术后3个月GERD-Q评分较术前明显下降［（5.7±0.7）分 vs. （10.7±1.6）分，P<0.05］，未发生食管裂孔疝复发以及其他远期并发症。联合手术组与单纯胃手术组病人在术中出血量、术后进食时间、引流管留置时间、及术后住院时间等方面差异均无统计学意义（P>0.05），在住院费用上两组差异无统计学意义［（7.9±1.9）万元 vs. （7.4±1.3）万元，P>0.05］，仅在手术时间上差异有统计学意义［（184.1±30.8）min  vs. （139.8±22.7）min，P<0.01］。结论    在条件允许情况下，腹腔镜胃部手术联合HH修补术可同时进行，一次手术治疗多种疾病，安全可行。

关键词: 腹腔镜手术, 食管裂孔疝, 联合胃部手术

Abstract: To explore the safety and feasibility of esophageal hiatal hernia (HH) repair surgery combined with laparoscopic gastric surgeries. Methods    A retrospective analysis was conducted on the perioperative and follow-up data of 37 patients who underwent combined esophageal hiatal hernia repair and laparoscopic gastric surgeries, and 28 patients who underwent only laparoscopic distal gastrectomy, at the General Surgery Department of Xuzhou Medical University Affiliated Hospital from December 2014 to November 2023. The intraoperative and postoperative conditions of patients undergoing combined surgery were summarized, and the clinical data of patients undergoing combined esophageal hiatal hernia repair and laparoscopic gastric surgeries (the combined distal gastrectomy group) and patients undergoing laparoscopic distal gastrectomy alone (the distal gastrectomy group) was compared. Results    The rate of patients with preoperative gastroesophageal reflux disease (GERD) experiencing postoperative GERD relief is 90.9%. The GERD-Q score significantly decreased at 3 months post-surgery compared to preoperative levels ［(5.7±0.7) vs. (10.7±1.6), P<0.05］, and there was no recurrence of hiatal hernia or other long-term complications. No statistically significant differences were observed in the intraoperative bleeding, postoperative eating time, drainage tube retention time, or postoperative hospital stay between the combined distal gastrectomy group and the distal gastrectomy group (P>0.05). The two groups also showed no difference in hospitalization expenses ［(79 000±19 000) Yuan vs. (74 000±13 000) Yuan, P>0.05］ but exhibited a statistical difference in surgical times ［（184.1±30.8）min  vs. （139.8±22.7）min，P<0.01］. Conclusion    Combining laparoscopic gastric surgery with esophageal hiatal hernia repair simultaneously when conditions permit can treat multiple diseases in unison and is a safe and feasible surgical approach.

Key words: laparoscopic surgery, hiatal hernia, combined gastric operation