探讨地市级医院初期开展腹腔镜下食管裂孔疝修补及胃底折叠术的技术要点及临床疗效。

回顾分析咸阳市中心医院2016年3月至2019年3月，行腹腔镜下食管裂孔疝修补、胃底折叠术31例患者的临床资料。按胃底折叠术的术式不同，分为Dor术式组、Toupet术式组、Nissen术式组。观察并记录各术式组患者的手术时间、术中出血量、住院时间。随访3~36个月时的并发症及复发率。

31例均行腹腔镜下食管裂孔疝修补联合胃底折叠术。其中Dor折叠4例、Toupe折叠3例、Nissen折叠24例；各术式手术时间分别为（60±4.5）、（68±6.3）、（70±9.2）min；各术式术中出血量分别为（21±4.8）、（24±5.4）、（30±9.1）ml；术后出院时间（7±2.1）、（8±2.8）、（9±2.4）d。31例患者术后不适症状均得到缓解，4例患者术后出现吞咽困难并发症，其中1例患者因保守对症治疗效果不理想，行二次手术拆除胃底折叠后好转，其余3例患者经对症治疗后缓解。31例患者术后随访，失访患者1例，随访3~36个月，中位时间28个月。经胃镜、上消化道造影检查，未复发且无其他并发症发生。

腹腔镜下食管裂孔疝修补、胃底折叠术安全、有效，微创优势明显，值得临床推广。

To explore the technical points and clinical effectiveness of laparoscopic hiatal hernia repair and fundoplication in municipal hospital.

We retrospectively analyzed clinical data of 31 patients who underwent laparoscopic hiatal hernia repair and fundoplication in Xianyang Central Hospital between March 2016 and March 2019. Different types of fundoplication were carried out including Dor fundoplication, Toupet fundoplication and Nissen fundoplication. The operative time, intraoperative blood loss and hospital stay of patients in each fundoplication group were observed and recorded. The rates of complications and recurrence were followed up for 3 to 36 months.

All 31 patients completed laparoscopic hiatal hernia repair and fundoplication. There were 4 cases of Dor fundoplication, 3 cases of Toupe fundoplication and 24 cases of Nissen fundoplication. The operative time of the Dor fundoplication was (60±4.5) minutes, the Toupet fundoplication was (68±6.3) minutes, the Nissen fundoplication was (70±9.2) minutes. The intraoperative blood loss was (21±4.8) ml for Dor fundoplication, (24±5.4) ml for Toupet fundoplication, (30±9.1) ml for Nissen fundoplication. The postoperative hospital stay was (7±2.1) days for Dor fundoplication, (8±2.8) days for Toupet fundoplication, (9±2.4) days for Nissen fundoplication. Clinical symptoms of all 31 patients had been alleviated effectively after operation. 4 patients had developed postoperative complications of dysphagia, one of them was relieved after removal of fundoplication by a second operation due to unsatisfactory conservative symptomatic treatment, the other 3 patients were relieved after symptomatic treatment. In 31 patients, 1 patient lost to follow up. The median follow-up time was 28 months (range, 3-36 months). Gastroscopy and upper gastrointestinal radiography showed no recurrence or other complications.

Laparoscopic repair of esophageal hiatal hernia and fundoplication is safe, effective, minimally invasive and worthy of clinical promotion.