观察分析腹腔镜下食管裂孔疝修补联合Nissen/Dor胃底折叠术治疗食管裂孔疝临床疗效及食管测压与pH值监测对长期疗效的预估意义。

回顾性分析2018年1月至2020年1月于河北北方学院附属第二医院收治的120例食管裂孔疝患者的临床资料，其中64例行腹腔镜下食管裂孔疝修补联合Nissen胃底折叠术（Nissen组），56例行腹腔镜下食管裂孔疝修补联合Dor胃底折叠术（Dor组）。术后随访1年，对比观察2组患者手术情况、住院时间、术后并发症、记录食管测压及pH检测等指标变化情况、Gerd Q、DeMeester评分等。

Nissen组术程以及术中出血量明显高于Dor组（P<0.05），2组总住院时间差异无统计学意义（P>0.05）。2组患者术后总并发症发生率比较，差异无统计学意义（P>0.05）；2组患者术后1年食管反流情况与DeMeester评分较术前均得到明显改善。Nissen组在减少反流次数、长反流次数和最长反流时间方面均优于Dor组（P<0.05）。2组在反流时间、酸反流时间百分比与DeMeester评分比较，差异均无统计学意义（P>0.05）；术后2组患者食管下括约肌压力、静息呼吸平均值、食管残余压较术前均显著提升（P<0.05），但2组间术后比较无明显差异（P>0.05）。术后2组患者食管松弛率、无效吞咽与Gerd Q评分均较术前也均明显降低，但2组间差异无统计学意义（P>0.05）。

腹腔镜疝修补术联合Nissen或Dor胃底折叠术治疗食管裂孔疝均有明显效果，临床应根据患者自身情况选择合适的手术方式。

To observe and analyze the clinical efficacy of laparoscopic hiatal hernia repair combined with Dor fundoplication in the treatment of hiatal hernia and the predictive significance of esophageal manometry and pH monitoring on long-term effectiveness.

The clinical data of 120 patients with hiatal hernia admitted to the Second Affiliated Hospital of Hebei Northern University from January 2018 to January 2020 were retrospectively analyzed, of which 64 patients underwent laparoscopic hiatal hernia repair combined with Nissen fundoplication (Nissen group), 56 cases underwent laparoscopic hiatal hernia repair combined with Dor fundoplication (Dor group). The patients were followed up for 1 year after the operation, and the operation conditions, hospitalization time, postoperative complications, changes in esophageal manometry and pH detection, and Gerd Q and DeMeester scores were compared between the two groups.

The operation course and intraoperative blood loss in the Nissen group were significantly higher than those in the Dor group (P<0.05), and there was no significant difference in the total hospitalization time between the two groups (P>0.05). There was no significant difference in the incidence of total postoperative complications between the two groups (P>0.05); the esophageal reflux and DeMeester scores of the two groups at 1 year after operation were significantly improved compared with those before operation. The Nissen group was better than the Dor group in reducing the number of regurgitations, the length of regurgitation and the longest regurgitation time (P<0.05). There was no significant difference in the reflux time, acid reflux time percentage and DeMeester score between the two groups (P>0.05); the lower esophageal sphincter pressure, resting breath average value and esophageal residual pressure in the two groups after operation were significantly increased compared with those before operation (P<0.05), but there was no significant difference between the two groups after surgery (P>0.05). The esophageal relaxation rate, invalid swallowing and Gerd Q score of the two groups after operation were also significantly lower than those before operation, but there was no significant difference between the two groups (P>0.05).

Laparoscopic hernia repair combined with Nissen or Dor fundoplication has an obvious effect in the treatment of hiatal hernia, and the appropriate surgical method should be selected according to the patient's own situation.