中国实用外科杂志

中国实用外科杂志

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腹腔镜食管裂孔疝修补术联合抗反流手术临床疗效研究（附835例报告）

克力木·阿不都热依木，阿力木江·麦斯依提，阿扎提江，张    成，皮尔地瓦斯   

  1. 新疆维吾尔自治区人民医院微创外科 疝和腹壁外科，新疆乌鲁木齐 830001
  • 出版日期:2015-11-01 发布日期:2015-10-29

  • Online:2015-11-01 Published:2015-10-29

摘要：

目的    探讨腹腔镜食管裂孔疝修补术联合抗反流手术治疗胃食管反流病（GERD）合并食管裂孔疝的安全性和疗效。方法    回顾性分析2005年9月至2015年5月新疆维吾尔自治区人民医院收治的835例GERD合并食管裂孔疝病人的临床资料，均行腹腔镜食管裂孔疝修补术+胃底折叠术。结果    835例均成功完成腹腔镜食管裂孔疝修补术+胃底折叠术，无一例中转开放手术。其中联合其他手术183例（21.9%）。手术时间55.3（40～90）min；术中出血量20.4（5～50）mL，无术中术后输血者。术后24～48 h全流质饮食。术后随访3个月至10年，平均37.5个月。56例（6.7%）病人术后出现并发症，其中吞咽困难28例，食管裂孔疝复发（折叠的胃底疝入胸腔）4例，症状复发18例，胃肠胀气综合征6例。结论    腹腔镜食管裂孔疝修补术+胃底折叠术安全有效、创伤小、恢复快、并发症少，并可联合手术治疗其他疾病，是GERD合并食管裂孔疝病人的理想选择。

关键词: 胃食管反流病, 食管裂孔疝修补术, 胃底折叠术, 腹腔镜

Abstract:

Laparoscopic anti-reflux surgery for gastroesophageal reflux disease with hiatal hernia: A clinical analysis of 835 cases        Kelimu.Abudureyimu，Alimujiang.Maisiyiti，Azhatijiang，et al. Department of Hernia and Abdominal Wall Surgery & Minimally Invasive Surgery，the People’s Hospital of Xinjiang Uyghur Autonomous Region，Urumqi 830001，China
Corresponding author：Kelimu.Abudureyimu，E-mail：klm6075@163.com
Abstract    Objective    To evaluate the efficacy and safety of laparoscopic hiatal hernioraphy and fundoplication for gastroesophageal reflux disease (GERD). Methods    The clinical data of 835 cases of GERD and hiatal hernia admitted from September 2005 to May 2015 in the People’s Hospital of Xinjiang Uyghur Autonomous Region were analyzed retrospectively. All the cases were performed laparoscopic hiatal hernioraphy and fundoplication. Results    Laparoscopic hiatal herniorrhaphy and fundoplication were successfully performed in all 835 cases without mortality or conversion. A total of 183 cases were performed combined operation，accounting for 21.9%. The duration of operation ranged from 40 to 90 min，and bleeding from 5 to 50 mL. No intraoperative or postoperative blood transfusion occurred. Liquid diet was performed in postoperative 24 to 48 h. All the cases were followed up for 3 months to 10 years (average 37.5 months). A total of 56 cases（6.7%） had postoperative complications, including 28 cases of postoperative dysphagia，4 cases of recurrent hiatal hernia (gastric wrap herniated into the chest) , 18 cases of recurrence of symptoms and 6 cases of gas bloating syndrome. Conclusion    Laparoscopic hiatal hernioraphy and fundoplication is safe and effective，an ideal choice for GERD patients with hiatal hernia due to advantages of less invasive，faster recovery and fewer complications. Also it can combine surgical treatment of other diseases.

Key words: gastroesophageal reflux disease, hiatal hernia repair, fundoplication, laparoscopy