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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) ›› 2024, Vol. 18 ›› Issue (05) : 507 -511. doi: 10.3877/cma.j.issn.1674-392X.2024.05.006

所属专题： 经典病例；

论著

腹腔镜疝修补术联合胃底折叠术治疗食管裂孔疝合并胃食管反流病40 例临床分析
任传富1, 杨志2, 徐恩2, 何梓芸3, 罗板鑫4, 陈新4, 夏雪峰1,2,3,†()   
  1. 1.210009 南京医科大学 鼓楼临床医学院 南京鼓楼医院普通外科
    2.210009 南京大学医学院附属鼓楼医院普通外科
    3.210046 南京，泰康仙林鼓楼医院普通外科
    4.210009 南京中医药大学 鼓楼临床医学院 南京鼓楼医院普通外科
  • 收稿日期:2024-08-23 出版日期:2024-10-18
  • 通信作者: 夏雪峰
  • 基金资助:
    江苏省卫生健康委医学科研面上项目（M2022096）泰康健投青年医学科研启动基金项目（2022002）南京鼓楼医院临床研究专项资金培育项目（2022-YXZX-XH-03）

Laparoscopic hernia repair with fundoplication for hiatal hernia with gastroesophageal reflux disease:A clinical analysis of 40 patients

Chuanfu Ren1, Zhi Yang2, En Xu2, Ziyun He3, Banxin Luo4, Xin Chen4, Xuefeng Xia†,1,2,3()   

  1. 1.Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing 210009, China
    2.Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210009, China
    3.Department of General Surgery, Taikang Xianlin Drum Tower Hospital, Nanjing 210046,China
    4.Department of General Surgery, Nanjing Drum Tower Hospital, Drum Tower Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210009, China
  • Received:2024-08-23 Published:2024-10-18
  • Corresponding author: Xuefeng Xia
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任传富, 杨志, 徐恩, 何梓芸, 罗板鑫, 陈新, 夏雪峰. 腹腔镜疝修补术联合胃底折叠术治疗食管裂孔疝合并胃食管反流病40 例临床分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 507-511.

Chuanfu Ren, Zhi Yang, En Xu, Ziyun He, Banxin Luo, Xin Chen, Xuefeng Xia. Laparoscopic hernia repair with fundoplication for hiatal hernia with gastroesophageal reflux disease:A clinical analysis of 40 patients[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 507-511.

目的

探讨腹腔镜食管裂孔疝修补术联合胃底折叠术治疗食管裂孔疝（HH）合并胃食管反流病（GERD）患者的可行性、临床效果及安全性。

方法

选取2023 年1—12 月南京鼓楼医院40 例行腹腔镜食管裂孔疝修补联合胃底折叠术的HH 合并GERD 患者，统计分析患者的临床基本资料、手术相关指标、术后并发症、手术前后的反流情况和食管压力变化。

结果

40 例腹腔镜食管裂孔疝修补术联合胃底折叠术均成功完成。手术平均时间（145.83±33.77）min，术中平均出血量（33.67±23.36）ml，术后平均住院时间（4.80±0.98）d，术后进食流质平均时间（1.82±0.64）d。随访无重症并发症、无死亡及HH 复发病例。患者术后6 个月的反流次数、长反流次数、反流时间、酸反流时间百分比、DeMeester 评分和胃食管反流病问卷量表评分较术前均明显改善（P＜0.05），食管下括约肌静息压和食管残余压较术前显著升高（P＜0.05），食管松弛率和无效吞咽比也较术前显著下降（P＜0.05）。

结论

腹腔镜食管裂孔疝修补术联合胃底折叠术是治疗HH 合并GERD 的安全可行的手术方法，能有效改善患者食管功能，减轻患者反流症状，具有明确的临床疗效。

关键词: 疝, 食管裂孔, 胃食管反流病, 腹腔镜手术, 胃底折叠术, 临床分析

Objective

To investigate the feasibility, clinical efficacy and safety of laparoscopic hiatal hernia repair with fundoplication for hiatal hernia (HH) with gastroesophageal reflux disease(GERD) patients.

Methods

A total of 40 patients with HH and GERD who underwent laparoscopic hiatal hernia repair and fundoplication at Drum Tower Hospital in Nanjing from January to December 2023 were selected. The clinical basic information, surgical related indicators, postoperative complications, the reflux situation and changes in esophageal pressure before and after surgery were analyzed.

Results

All 40 cases of laparoscopic HH repair with fundoplication were successfully completed. The average surgery time was (145.83±33.77) minutes, the average intraoperative blood loss was (33.67±23.36) ml, the average postoperative hospital stay was (4.80±0.98) days, and the average postoperative time to consume fluids was(1.82±0.64) days. There were no serious complications, deaths, or recurrence cases during follow-up. At 6 months after surgery, number of refluxes, number of long reflux, reflux time, percentage of acid reflux time,DeMeester score, and Gerd Q score were significantly improved compared to preoperative levels (P＜0.05). The resting pressure of the lower esophageal sphincter and residual pressure of the esophagus increased significantly compared to preoperative levels (P ＜ 0.05), while the esophageal relaxation rate and ineffective swallowing ratio also decreased significantly compared to preoperative levels (P＜0.05).

Conclusion

Laparoscopic HH repair with fundoplication is a safe and feasible surgical method for treating HH with GERD. It can effectively improve the patient's esophageal function, reduce the patient's reflux symptoms, and has clear clinical efficacy.

Key words: Hernia, hiatal, Gastroesophageal reflux disease(GERD), Laparoscopic surgery, Fundoplication, Clinical analysis
表1 40 例患者手术前后胃食管反流情况比较（±s ）
观察时间 反流次数(次) 反流时间(h) 酸反流时间百分比(%) 长反流次数(次) DeMeester评分 Gerd Q评分
术前 110.51±27.07 2.69±1.60 10.63±4.78 5.75±2.09 30.76±7.65 12.35±1.64
术后6个月 24.75±7.54 1.09±0.63 5.37±3.31 2.15±1.17 12.99±3.59 6.93±1.31
t值 19.96 7.72 9.09 9.51 15.18 17.75
P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001
表2 40 例患者手术前后食管压力比较（±s ）
观察时间 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 9.63±4.87 2.38±1.45 72.53±9.39 21.35±6.59
术后6个月 20.65±4.67 10.08±3.33 49.56±11.62 10.05±3.74
t值 9.91 12.65 11.19 10.18
P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001
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