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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) : 40 -43. doi: 10.3877/cma.j.issn.1674-392X.2022.01.009

临床论著

腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效
罗冰清1, 张秋子2, 张也1, 王新波1,†()   
  1. 1. 075100　张家口，河北北方学院附属第二医院普通外科
    2. 075000　张家口，河北北方学院附属第一医院内分泌科
  • 收稿日期:2019-12-28 出版日期:2022-02-18
  • 通信作者: 王新波
  • 基金资助:
    河北省重点研发计划自筹项目(182777204)

Clinical efficacy of laparoscopic repair of esophageal hiatal hernia combined with modified DOR fundoplication in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease

Bingqing Luo1, Qiuzi Zhang2, Ye Zhang1, Xinbo Wang1,†()   

  1. 1. General Surgery, the Second Affiliated Hospital of Hebei North University, Zhangjiakou 075100, Hebei Province, China
    2. Department of Endocrinology, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei Province, China
  • Received:2019-12-28 Published:2022-02-18
  • Corresponding author: Xinbo Wang
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罗冰清, 张秋子, 张也, 王新波. 腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效[J/OL]. 中华疝和腹壁外科杂志(电子版), 2022, 16(01): 40-43.

Bingqing Luo, Qiuzi Zhang, Ye Zhang, Xinbo Wang. Clinical efficacy of laparoscopic repair of esophageal hiatal hernia combined with modified DOR fundoplication in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(01): 40-43.

目的

探讨腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝（HH）合并胃食管反流病患者的临床疗效。

方法

选择2016年1月至2019年1月河北北方学院附属第二医院收治的108例食管裂孔疝合并胃食管反流病患者开展回顾性研究，按照不同手术方式将患者分为2组，每组患者54例。对照组行常规开腹手术，联合组行腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术，比较2组患者术前及术后6个月反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分。

结果

2组术前反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异无统计学意义（P>0.05）；2组患者术后6个月反流症状与术前比较，均得到明显改善，差异有统计学意义（P<0.05）；2组术后反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异有统计学意义（P<0.05）。联合组患者的手术时间、术中出血量及术后住院时长均明显优于对照组，差异有统计学意义（P<0.05）。

结论

腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术对HH合并胃食管反流病患者效果显著，有利于患者身体快速恢复，微创、安全且近期疗效满意。

关键词: 腹腔镜, 食管裂孔疝, 疝修补术, 胃食管反流病
Objective

To investigate the clinical effect of laparoscopic repair of esophageal hiatal hernia combined with modified DOR fundoplication in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease.

Methods

108 patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease treated in the Second Affiliated Hospital of Hebei North University from January 2016 to January 2019 were selected for retrospective study. The patients were divided into two groups according to different surgical methods, with 54 patients in each group. The control group received routine open surgery, and the combined group received laparoscopic hiatal hernia (HH) repair combined with modified DOR fundoplication. The reflux time, reflux times, DeMeester score, lower esophageal sphincter pressure and Gerd Q scale score before and 6 months after operation were compared between the two groups.

Results

There was no significant difference in preoperative reflux time, reflux times, DeMeester score, lower esophageal sphincter pressure and Gerd Q scale between the two groups (P>0.05). The reflux symptoms of the two groups were significantly improved 6 months after operation compared with those before operation (P<0.05). There were significant differences in postoperative reflux time, reflux times, DeMeester score, lower esophageal sphincter pressure and Gerd Q scale between the two groups (P<0.05). The operation time, intraoperative bleeding and postoperative hospital stay in the combined group were significantly better than those in the control group (P<0.05).

Conclusion

Laparoscopic HH repair combined with modified DOR fundoplication is effective in patients with HH complicated with gastroesophageal reflux disease, which is conducive to rapid recovery, minimally invasive, safe and has satisfactory short-term efficacy.

Key words: Laparoscopes, Hiatal hernia, Herniorrhaphy, Gastroesophageal reflux disease
表1 2组患者一般资料比较
组别 例数 年龄(岁, ±s) 性别(例) BMI(kg/m2, ±s) 病程(年, ±s) 疝的类型(例)
男性 女性 滑动型食管裂孔疝 食管裂孔旁疝 混合型食管裂孔疝 巨大型食管裂孔疝
对照组 54 48.87±7.16 28 26 29.74±1.75 4.23±1.06 21 21 7 5
联合组 54 49.36±7.24 25 29 29.62±1.70 4.41±1.12 22 20 8 4
t/χ2值   0.548 0.333 0.361 0.858 0.055 0.039 0.077 0.121
P值   0.586 0.564 0.719 0.393 0.814 0.843 0.781 0.728
表2 2组患者术前及术后6个月24 h食管pH结果比较（±s）
项目 对照组(54例) 联合组(54例) t值 P值
反流时间(h)        
  术前 2.07±1.92 1.77±1.36 1.986 0.113
  术后6个月 1.51±1.13* 0.24±0.17* 2.753 0.037
反流次数(次)        
  术前 120.31±81.79 110.37±61.47 4.721 0.103
  术后6个月 31.42±18.76* 14.37±10.59* 7.319 0.006
DeMeester评分(分)        
  术前 28.24±12.34 15.23±11.27 1.546 0.271
  术后6个月 7.37±4.25* 3.14±2.38* 0.437 0.025
食管下括约肌压力(mmHg)        
  术前 7.32±3.68 8.02±1.16 0.286 0.753
  术后6个月 12.93±6.98* 20.67±11.98* 4.538 0.027
Gerd Q量表评分(分)        
  术前 10.93±2.03 10.68±1.67 0.783 0.615
  术后6个月 8.22±1.54* 6.37±1.31* 1.098 0.034
表3 2组患者的围手术期情况比较（±s）
组别 例数 手术时间(min) 术中出血量(ml) 术后住院时长(d)
对照组 54 164.83±31.96 135.10±25.67 18.05±3.21
联合组 54 135.42±24.08 105.64±23.18 15.04±2.03
t值   5.401 6.259 5.824
P值   <0.001 <0.001 <0.001
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