胃底折叠术预防食管裂孔疝术后并发症的研究进展

doi:10.3877/cma.j.issn.1674-392X.2024.05.002

食管裂孔疝的外科治疗通常采用疝修补术联合胃底折叠术的方式，恰当的胃底折叠术能有效预防胃食管反流病的发生。胃底折叠方式的选择目前没有统一的定论，外科医生通常根据经验和偏好选择相应的胃底折叠术。其中以Nissen 胃底折叠术最多见，但是存在术后吞咽困难、腹胀等并发症。随着微创观念的发展，近年也出现了多种创伤更小、更符合生理结构的胃底折叠术，供医生和患者选择。本文对比了多种胃底折叠术的优缺点，对胃底折叠术预防食管裂孔疝术后并发症的前沿研究及新进展进行系统综述。

关键词: 疝, 食管裂孔, 胃底折叠术, 胃食管反流病

The surgical treatment of hiatal hernia usually adopts hernia repair combined with fundoplication. Proper fundoplication can effectively prevent gastroesophageal reflux disease. The choice of fundoplication is not unanimous, and surgeons usually choose fundoplication according to their experience and preference. Nissen fundoplication is the most common, but the postoperative complications such as dysphagia and bloating caused by Nissen fundoplication are distressing. With the development of the concept of minimally invasive surgery, a variety of fundoplications with smaller trauma and more physiological structure have been invented in recent years for doctors and patients to choose from. In this review, the advantages and disadvantages of fundoplication were compared, and the advanced research and new progress of fundoplication in preventing postoperative complications of hiatal hernia were reviewed systematically.

Key words: Hernia, hiatal, Fundoplication, Gastroesophageal reflux disease

图1 食管裂孔腔镜所见

图2 食管裂孔疝修补术

图3 Nissen 胃底折叠术

图4 Toupet 胃底折叠术^[27]

图5 Dor 胃底折叠术

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Research progress of fundoplication in preventing postoperative complications of hiatal hernia

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Research progress of fundoplication in preventing postoperative complications of hiatal hernia