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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 36 -39. doi: 10.3877/cma.j.issn.1674-392X.2022.01.008

临床论著

腹腔镜疝修补术结合Nissen胃底折叠术治疗胃食管反流合并食管裂孔疝的疗效
李娜1, 侯颖2,†(), 董长城3   
  1. 1. 014010　内蒙古包头，内蒙古包钢医院健康体检科
    2. 014010　内蒙古包头，内蒙古包钢医院消化内科
    3. 014010　内蒙古包头，内蒙古包钢医院肝胆外科
  • 收稿日期:2020-12-19 出版日期:2022-02-18
  • 通信作者: 侯颖
  • 基金资助:
    包头市科技计划项目(2019z3010-02)

Efficacy of laparoscopic hernia repair combined with Nissen fundus folding in the treatment of patients with gastroesophageal reflux complicated with hiatal hernia

Na Li1, Ying Hou2,†(), Changcheng Dong3   

  1. 1. Physical Examination Department, Baotou Iron and Steel Hospital, Baotou 014010, Inner Mongolia, China
    2. Digestive Department, Baotou Iron and Steel Hospital, Baotou 014010, Inner Mongolia, China
    3. Department of Hepatobiliary Surgery, Baotou Iron and Steel Hospital, Baotou 014010, Inner Mongolia, China
  • Received:2020-12-19 Published:2022-02-18
  • Corresponding author: Ying Hou
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引用本文：

李娜, 侯颖, 董长城. 腹腔镜疝修补术结合Nissen胃底折叠术治疗胃食管反流合并食管裂孔疝的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(01): 36-39.

Na Li, Ying Hou, Changcheng Dong. Efficacy of laparoscopic hernia repair combined with Nissen fundus folding in the treatment of patients with gastroesophageal reflux complicated with hiatal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(01): 36-39.

目的

分析腹腔镜疝修补术结合Nissen胃底折叠术治疗胃食管反流合并食管裂孔疝患者的临床疗效观察。

方法

选择内蒙古包钢医院2019年7月至2020年5月就诊的80例胃食管反流合并食管裂孔疝患者，按不同手术方式分为A组和B组，每组患者40例。A组采用腹腔镜疝修补术+Nissen胃底折叠术，B组采用腹腔镜疝修补术+Dor胃底折叠术。比较2组患者手术情况、食管反流情况、食管压力、消化病生存质量指数（GLQI）评分、胃食管反流病疗效评分（GERD-Q）、复发率以及不良反应情况。

结果

2组患者手术情况差异均无统计学意义（P>0.05）；术后3个月，反流时间、次数，长反流次数、酸反流时间百分比明显改善，且A组改善幅度更明显（P<0.05）；食管残余压平均值、下段括约肌压力、松弛率和无效吞咽率均明显改善，且A组改善情况优于B组（P<0.05）；2组患者GLQI与GERD-Q评分均有所改善，且A组GLQI评分高于B组，GERD-Q评分低于B组（P<0.05）；2组不良反应和复发率比较差异无统计学意义（P>0.05）。

结论

腹腔镜疝修补术联合Nissen胃底折叠术对抗反流，减轻术后吞咽困难具有明显效果，有效改善患者生活质量和食管下括约肌压力安全有效。

关键词: 腹腔镜, 胃食管反流, 疝，食管裂孔, 胃底折叠术
Objective

To analyze the clinical efficacy of laparoscopic hernia repair combined with Nissen fundus folding in the treatment of patients with gastroesophageal reflux complicated with hiatal hernia.

Methods

Eighty patients with gastroesophageal reflux complicated with hiatal hernia in the Department of Gastroenterology of Baogang Hospital of Inner Mongolia from July 2019 to May 2020 were selected as the research subjects. They were divided into group A (40 cases) and B (40 cases). Group A received laparoscopic herniorrhaphy with Nissen fundus folding, and group B received laparoscopic herniorrhaphy with Dor fundus folding. The operative conditions and esophageal reflux were compared between the two groups , esophageal pressure, digestive disease quality of life index (GLQI) grade, gastroesophageal reflux disease curative effect (GERD-Q), recurrence rate, and adverse reactions occurred.

Results

There was no statistical significance in the operation situation between the two groups (P>0.05). Three months after operation, the percentage of reflux time, times, long reflux times and acid reflux time were significantly improved, and the improvement was more obvious in group A (P<0.05). The mean value of esophageal residual pressure, lower sphincter pressure, relaxation rate and invalid swallowing rate were significantly improved, and the improvement was better in group A than in group B (P<0.05). GLQI and GERD-Q scores were improved in both groups, and the GLQI score in group A was higher than that in group B, while the GERD-Q score was lower than that in group B (P<0.05). There was no statistical significance in adverse reactions and recurrence rates between the two groups (P>0.05).

Conclusion

Laparoscopic hernia repair combined with Nissen fundus foldus has a significant effect on the inhibition of reflux and postoperative dysphagia, which not only improves the pressure of the lower esophageal sphincter, but also improves the lives of patients, which is safe and effective.

Key words: Laparoscopes, Gastroesophageal reflux, Hernia, hiatal, Fundoplication
表1 2组手术情况比较（±s）
组别 例数 手术时间(min) 术中出血量(ml) 术后进食时间(d) 住院时间(d)
A组 40 87.04±16.94 35.88±5.72 2.42±1.15 8.01±1.88
B组 40 85.26±16.55 34.26±5.67 2.53±1.32 7.89±1.84
t值   0.475 1.272 0.397 0.289
P值   0.636 0.207 0.692 0.774
表2 2组食管反流情况比较（±s）
组别 例数 反流次数(次) 反流时间(h) 酸反流时间百分比(%) 长反流次数(次)
术前 术后3个月 术前 术后3个月 术前 术后3个月 术前 术后3个月
A组 40 105.84±12.53 17.62±2.00*# 2.61±0.27 0.51±0.14*# 9.81±4.37 3.29±1.07*# 5.25±1.24 0.55±0.36*#
B组 40 105.01±12.42 18.81±2.54* 2.55±0.29 0.63±0.19* 9.95±4.48 4.03±1.11* 5.13±1.22 1.04±0.47*
t值   0.298 2.328 0.958 3.216 0.141 3.036 0.436 2.03
P值   0.767 0.023 0.341 0.002 0.888 0.003 0.664 0.046
表3 2组食管压力比较（±s）
组别 例数 食管下括约肌静息压平均值(mmHg) 食管残余压平均值(mmHg) 食管松弛率(%) 无效吞咽比(%)
术前 术后3个月 术前 术后3个月 术前 术后3个月 术前 术后3个月
A组 40 6.85±1.53 16.44±3.13*# 2.45±0.57 5.37±0.83*# 73.36±10.43 48.35±6.27*# 17.04±2.81 8.26±1.12*#
B组 40 6.82±1.53 14.86±3.08* 2.56±0.58 4.96±0.76* 72.49±10.21 51.33±6.45* 17.13±2.87 8.97±1.25*
t值   0.088 2.276 0.856 2.304 0.377 2.095 0.142 2.675
P值   0.93 0.026 0.395 0.024 0.707 0.039 0.888 0.009
表4 2组GLQI与GERD-Q评分比较（分，±s）
组别 例数 GLQI GERD-Q
术前 术后3个月 术前 术后3个月
A组 40 54.96±6.91 73.86±9.54*# 12.87±2.38 4.96±1.08*#
B组 40 54.21±6.88 69.47±9.31* 12.25±2.33 5.64±1.14*
t值   0.207 2.083 1.177 2.739
P值   0.837 0.041 0.243 0.008
表5 2组不良反应与复发率比较[例（%）]
组别 例数 不良反应 复发率
B组 40 6(15.00) 1(2.50)
A组 40 7(17.50) 0
χ2值   0.092 1.013
P值   0.762 0.314
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