目的

探讨右侧主操作孔联合胃短血管（SGV）离断技术在腹腔镜Nissen 胃底折叠术中的解剖显露优势、安全性及功能预后。

方法

回顾性分析2020 年4 月至2023 年6 月于成都市第三人民医院接受腹腔镜Nissen 胃底折叠术的胃食管反流病（GERD）或食管裂孔疝（HH）28 例患者资料。术者站立于患者右侧，采用五孔法操作，通过牵拉胃后壁及SGV 与脾上极血管垂直化策略精准离断SGV，观察围手术期指标（手术时间、出血量、并发症）及术后功能恢复[反流控制、吞咽困难、胃食管反流病健康相关生活质量（GERD-HRQL）问卷评分]。

结果

28 例患者均成功完成手术，平均总手术时间（123.89±23.48）min，平均SGV 离断时间（11.14±3.51）min，术中中位出血量5（5，10）ml，无脾损伤、胃壁穿孔及中转开腹病例。术后3 d，无吞咽全流质困难者；术后3个月，GERD-HRQL 评分较术前显著降低[（6.68±0.82）分比（11.07±2.62）分，P＜0.001）]。超重及肥胖组（体重指数≥25 kg/m²）的手术时间、出血量与非超重组比较[（119.28±4.55）min 比（132.20±9.11）min，P=0.226；（10.00±5.27）ml 比（7.78±4.61）ml，P=0.256]，差异均无统计学意义。

结论

右侧主操作孔联合SGV 离断技术通过优化解剖显露路径，能降低脾损伤风险，术后反流控制良好，尤其适用于肥胖及复杂食管裂孔疝患者。但需多中心随机对照研究进一步验证其长期疗效。

Objective

To investigate the anatomical exposure advantages, safety, and functional prognosis of the right main working port combined with short gastric vessels (SGV) disconnection technique in laparoscopic Nissen fundoplication.

Methods

Retrospective analysis was conducted in 28 patients with gastroesophageal reflux disease (GERD) or hiatal hernia (HH) who underwent laparoscopic Nissen fundoplication at Chengdu Third People's Hospital from April 2020 to June 2023.The surgeon stood on the right side of the patient, using a five-port technique.By retracting the posterior gastric wall and vertically aligning the SGV with the splenic upper pole vessels, precise SGV disconnection was achieved.Perioperative indicators (operative time, blood loss, complications) and postoperative functional recovery (reflux control, dysphagia, GERD-HRQL questionnaire scores) were evaluated.

Results

All 28 patients successfully completed the procedure.The mean total operative time was (123.89±23.48) min,with mean SGV disconnection time of (11.14±3.51) min, and median intraoperative blood loss of 5 (5, 10)ml.No splenic injury, gastric perforation, or conversion to open surgery occurred.No postoperative dysphagia for full liquids occurred 3 day after surgery.GERD-HRQL questionnaire scores at 3 months after surgery significantly decreased compared to preoperative scores [(6.68±0.82) vs.(11.07±2.62),P<0.001].Overweight/obese patients (BMI ≥25 kg/m²) showed no significant differences in operative time or blood loss compared to non-overweight patients [(119.28±4.55) min vs.(132.2±9.11) min,P=0.226; (10.00±5.27) ml vs.(7.78±4.61) ml, P=0.256].

Conclusion

The right main working port combined with SGV disconnection optimizes anatomical exposure, reduces splenic injury risk, and achieves favorable reflux control, particularly in obese patients and complex hiatal hernia cases.However,multicenter randomized controlled trials are warranted to validate its long-term efficacy.