评估基于心下囊解剖行腹腔镜下食管裂孔疝补片修补术（LHHR）治疗大食管裂孔疝（MHH）患者的安全性和有效性，为临床提供循证参考。

回顾性分析2021年1月至2024年12月，在中国科学技术大学附属第一医院疝及肥胖外科接受基于心下囊解剖行腹腔镜下食管裂孔疝补片修补术手术治疗的40例MHH患者的临床资料。借助胃镜、胃食管反流病问卷（GERD-Q），对患者术前及术后的反流症状变化展开评估。主要研究指标为术中右侧胸膜破裂和食管肌层损伤结果、引流情况，次要指标包括术后并发症、住院时长。

40例患者中，2例（5%）失访，中位随访时间为24（4~48）个月；1例于出院后2个月因急性脑梗死死亡。术中有28例患者成功辨识出心下囊结构，均未发生右侧胸膜破裂或食管肌层损伤；另有12例患者未能识别出心下囊，其中5例出现右侧胸膜破裂、1例食管肌层损伤。中位疝缺损直径为4.5（4.5~5.0）cm，中位手术时长为108（60~310）min，中位术中出血量为10（10~50）ml；术中25例患者放置引流管，中位留置时间为2（1~7）d，中位术后住院时长3.5（2.5~4.5）d。术前GERD-Q平均为（11.38±0.98）分，术后降至（7.57±0.73）分，差异有统计学意义（P<0.001）。

基于心下囊解剖进行腹腔镜下食管裂孔疝补片修补术，能够有效降低术中胸膜破裂和食管肌层损伤，提高手术安全性。

To evaluate the safety and efficacy of laparoscopic hiatal hernia repair (LHHR) based on infracardiac bursa in the treatment of massive hiatal hernia (MHH), and to provide evidence-based reference for clinical practice.

A retrospective analysis of clinical data from January 2021 to December 2024 of 40 MHH patients in Hernia and Obesity Surgery at the First Hospital, Affiliated with the University of Science and Technology of China, who received surgical treatment based on infracardiac bursa for massive hiatal hernia repair under laparoscopy. The changes of reflux symptoms before and after surgery were assessed by gastroscopy and the gastroesophageal reflux disease questionnaire (GERD-Q). The main study indicators were right-sided pleural rupture and esophageal muscle injury results during surgery, and diverticulation. Secondary indicators included postoperative complications and length of hospital stay.

Of the 40 patients, 2 (5%) were lost to follow-up, and the median follow-up time was 24 (4-48) months. One died of acute cerebral infarction two months after discharge. Twenty-eight patients successfully identified the structure of the infracardiac bursa during surgery, and none suffered rupture of the right pleural membrane or damage to the oesophageal muscles. A further 12 patients failed to identify the infracardiac bursa, including five with a rupture of the right pleural membrane and one with damage to the oesophageal muscle. The median hernia defect diameter was 4.5 (4.5-5.0) cm, the median operative duration was 108 (60-310) min, and the median intraoperative bleeding was 10 (10-50) ml. The median indwelling time was 2 (1-7) days, and the median postoperative hospital stay was 3.5 (2.5-4.5) days. The average score of GERD-Q was (11.38±0.98) points preoperatively and decreased to (7.57±0.73) points postoperatively (P<0.001).

Based on infracardiac bursa, laparoscopic hiatal hernia repair can effectively reduce the rupture of the pleura and damage to the muscles of the esophagus during surgery, and improve surgical safety.