探讨在腹腔镜食管裂孔疝修补术＋胃底折叠术中保留迷走神经肝支的可行性及对术后胆囊功能的影响。

本回顾性队列研究，纳入2019年1月至2023年12月在南方医科大学深圳医院普外科行腹腔镜食管裂孔疝修补术的73例胃食管反流病合并食管裂孔疝患者作为研究对象，排除17例同期行其他手术、2例复发疝或Ⅳ型疝患者，其余54例患者依据术中是否保留迷走神经肝支，分为迷走神经肝支保留组（n=17）和迷走神经肝支切除组（n=37）。比较2组患者的手术时间、手术出血量、住院时间、术后并发症等指标的差异。所有患者在术后1、6、12及36个月进行常规门诊随访，并行腹部超声或CT检查监测胆囊情况，统计胆囊结石发生率。

迷走神经肝支保留组及切除组患者在手术时长、术中出血量、住院时间、并发症等方面比较，差异均无统计学意义（P>0.05）。迷走神经肝支切除组，术后6个月复查发现2例无症状性胆囊结石，且随着时间延长，胆囊结石患者增多，3年随访时，发现9例（24.30%）胆囊结石患者；其余患者影像检查均未发现胆囊结石及其他胆囊病变发生。迷走神经肝支切除组术后3年时胆囊结石发生率明显高于迷走神经肝支保留组（24.30%比0.0%），差异有统计学意义（P<0.05）。

腹腔镜下食管裂孔疝修补＋胃底折叠术中保留迷走神经肝支是可行的，短期内可减少对胃肠道功能的影响，有助于术后恢复，远期可能有助于减少胆囊结石的形成，但是否由于保留迷走神经肝支所致仍有待进一步研究。

To investigate the feasibility of preserving the hepatic branch of the vagus nerve during laparoscopic hiatal hernia repair combined with fundoplication and its effect on postoperative gallbladder function.

This retrospective cohort study included 73 patients with gastroesophageal reflux disease complicated by hiatal hernia who underwent laparoscopic hiatal hernia repair in the Department of General Surgery, Shenzhen Hospital, Southern Medical University, from January 2019 to December 2023. Seventeen patients who underwent other concomitant procedures and two patients with recurrent hernia or type IV hernia were excluded. The remaining 54 patients were divided into the hepatic branch of the vagus nerve preservation group (n=17) and the hepatic branch of the vagus nerve resection group (n=37) according to whether the hepatic branch of the vagus nerve was preserved during surgery. Operative time, intraoperative blood loss, length of hospital stay, postoperative complications, and other indicators were compared between the two groups. All patients underwent routine outpatient follow-up at 1, 6, 12, and 36 months after surgery, and abdominal ultrasonography or computed tomography (CT) was performed to monitor gallbladder status. The incidence of gallstones was recorded.

There were no statistically significant differences between the hepatic branch of the vagus nerve preservation group and the resection group in operative time, intraoperative blood loss, length of hospital stay, or complications (P>0.05). In the hepatic branch of the vagus nerve resection group, two cases of asymptomatic gallstones were detected at the 6-month postoperative follow-up. With prolonged follow-up, the number of patients with gallstones increased. At the 3-year follow-up, gallstones were detected in nine patients (24.30%). No imaging evidence of gallstones or other gallbladder lesions was observed in the remaining patients. At 3 years after surgery, the incidence of gallstones in the hepatic branch of the vagus nerve resection group was significantly higher than that in the hepatic branch of the vagus nerve preservation group (24.30% vs. 0.0%), and the difference was statistically significant (P<0.05).

Preserving the hepatic branch of the vagus nerve during laparoscopic hiatal hernia repair combined with fundoplication is feasible. In the short term, it may reduce the impact on gastrointestinal function and facilitate postoperative recovery. In the long term, it may help reduce the formation of gallstones; however, whether this effect is attributable to preservation of the hepatic branch of the vagus nerve requires further investigation.