分享并探讨机器人"3＋1"模式在食管裂孔疝修补术中手术安全性及诊疗经验。

本研究为单中心回顾性病例系列研究，纳入新疆维吾尔自治区人民医院微创、疝和腹壁外科自2022年1月至2025年1月行达芬奇机器人辅助腹腔镜下食管裂孔疝修补术的145例患者，均采用"3＋1"模式进行trocar布孔并完成手术。采用门诊预约、线上问诊、电话方式，随访患者术后好转情况，疝复发及并发症情况，随访截止日期为2025年12月。

145例患者均顺利完成机器人辅助腹腔镜下食管裂孔疝修补术＋胃底折叠术，无中转开腹、开胸，其中137例行Nissen胃底折叠术，2例行Dor胃底折叠术，6例行Toupet胃底折叠术。疝缺损面积平均为（47.5±17.3）cm²，手术时间平均为（67.5±18.8）min；术中出血量平均为（15.0±5.0）ml，术后住院时间平均为（6.5±2.5）d，手术费用平均为（6.8±1.0）万元。术后随访平均时间为（30.5±7.5）个月，术后反酸、烧心、胸痛等症状均较术前明显好转；随访期间无胸腔积液、肺部感染、伤口感染，无复发病例。

机器人"3＋1"模式辅助食管裂孔疝修补术具有较高的手术安全性，其trocar布孔方法简便、规范，可重复性和操作性强。

To share and discuss the surgical safety and clinical experience of the robotic "3+1" mode in hiatal hernia repair.

This study was a single-center retrospective case series. A total of 145 patients who underwent da Vinci robot-assisted laparoscopic hiatal hernia repair in the Department of Minimally Invasive, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, from January 2022 to January 2025 were included. All patients underwent trocar placement using the "3+1" mode, and the operations were completed accordingly. Postoperative improvement, hernia recurrence, and complications were followed up through outpatient appointments, online consultations, and telephone calls. The follow-up deadline was December 2025.

All 145 patients successfully underwent robot-assisted laparoscopic hiatal hernia repair combined with fundoplication, without conversion to open abdominal or thoracic surgery. Among them, 137 patients underwent Nissen fundoplication, 2 underwent Dor fundoplication, and 6 underwent Toupet fundoplication. The mean hernia defect area was (47.5±17.3) cm², the mean operative time was (67.5±18.8) min, the mean intraoperative blood loss was (15.0±5.0) ml, the mean postoperative hospital stay was (6.5±2.5) days, and the mean surgical cost was RMB (6.8±1.0)×10⁴ yuan. The mean postoperative follow-up duration was (30.5±7.5) months. Postoperative symptoms such as acid reflux, heartburn, and chest pain were markedly improved compared with those before surgery. During follow-up, no pleural effusion, pulmonary infection, wound infection, or recurrence was observed.

Robot-assisted hiatal hernia repair using the robotic "3+1" mode has high surgical safety. The trocar placement method is simple, standardized, highly reproducible, and highly operable.