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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) ›› 2026, Vol. 20 ›› Issue (03) : 284 -288. doi: 10.3877/cma.j.issn.1674-392X.2026.03.008

论著

腹腔镜合成补片修补Ⅲ型食管裂孔疝的中期疗效分析：单中心回顾性研究
傅晓键, 黄先觉, 储宇霄, 朱志远, 姚琪远, 花荣†()   
  1. 200040　上海，复旦大学附属华山医院普外科肥胖疝外科中心
  • 收稿日期:2026-04-13 出版日期:2026-06-18
  • 通信作者: 花荣

Mid-term efficacy analysis of laparoscopic repair with synthetic mesh for type Ⅲ hiatal hernia: A single-center retrospective study

Xiaojian Fu, Xianjue Huang, Yuxiao Chu, Zhiyuan Zhu, Qiyuan Yao, Rong Hua†()   

  1. Department of General Surgery, Center for Obesity and Hernia Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2026-04-13 Published:2026-06-18
  • Corresponding author: Rong Hua
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傅晓键, 黄先觉, 储宇霄, 朱志远, 姚琪远, 花荣. 腹腔镜合成补片修补Ⅲ型食管裂孔疝的中期疗效分析：单中心回顾性研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(03): 284-288.

Xiaojian Fu, Xianjue Huang, Yuxiao Chu, Zhiyuan Zhu, Qiyuan Yao, Rong Hua. Mid-term efficacy analysis of laparoscopic repair with synthetic mesh for type Ⅲ hiatal hernia: A single-center retrospective study[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2026, 20(03): 284-288.

目的

探讨腹腔镜合成补片修补术治疗Ⅲ型食管裂孔疝的中期疗效。

方法

本研究为回顾性病例系列研究，纳入2017年1月至2023年12月，在复旦大学附属华山医院普外科肥胖疝外科中心，采用合成补片进行腹腔镜食管裂孔疝补片修补术治疗的62例Ⅲ型患者，分析患者的围手术期情况、术后并发症及随访数据。

结果

62例患者均顺利完成腹腔镜手术，无中转开腹。平均手术时间（114.5±35.7）min，术后住院时间5.0（4.0，6.0）d。平均随访（72±24.6）个月，术后GerdQ评分较术前明显下降[（6.4±1.0）分比（8.6±2.1）分，P<0.05]，需质子泵抑制剂治疗人数较术前显著减少（7例比41例）。术后解剖复发率8.2%（5/61），症状复发率8.2%（5/61），吞咽困难发生率16.4%（10/61）。患者相关因素与复发及吞咽困难无明显相关性。

结论

腹腔镜合成补片修补术治疗Ⅲ型食管裂孔疝安全可行，可有效改善临床症状，并降低复发风险。

关键词: 疝，食管裂孔, 腹腔镜, 补片修补, 复发, 吞咽困难
Objective

To explore the mid-term efficacy of laparoscopic repair with synthetic mesh for type Ⅲ hiatal hernia.

Methods

This study is a retrospective case series study. A total of 62 patients with typeⅢ hiatal hernia who underwent laparoscopic hiatal hernia repair with synthetic mesh in the Center for Obesity and Hernia Surgery , Department of General Surgery, Huashan Hospital, Fudan University from January 2017 to December 2023 were included. The perioperative conditions, postoperative complications, and follow-up results of the patients were analyzed.

Results

All 62 patients successfully completed laparoscopic surgery without conversion to open surgery. The average operation time was (114.5±35.7) minutes, and the average postoperative hospital stay was 5.0(4.0, 6.0) days. The average follow-up period was (72±24.6) months. The GerdQ score after surgery was significantly lower than that before surgery [(6.4±1.0) points vs (8.6±2.1) points, P<0.05], and the number of patients requiring proton pump inhibitor treatment significantly decreased (7 vs 41). The postoperative anatomical recurrence rate was 8.2% (5/61), the symptom recurrence rate was 8.2% (5/61), and the incidence of dysphagia was 16.4% (10/61). Patient-related factors were not significantly correlated with recurrence or dysphagia.

Conclusion

Laparoscopic repair with synthetic mesh for type Ⅲ hiatal hernia is safe and feasible. It can effectively improve clinical symptoms, and reduce the risk of recurrence.

Key words: Hernia, hiatal, Laparoscopy, Mesh repair, Recurrence, Dysphagia
图1 腹腔镜合成补片修补Ⅲ型食管裂孔疝手术情况　1A　缝合膈肌脚；1B　置入Y型补片；1C　钉枪固定补片；1D　不可吸收缝线加固补片；1E　胃底折叠；1F　折叠襻与膈肌脚固定
表1 腹腔镜合成补片修补Ⅲ型食管裂孔疝患者基线资料（n=62）
项目 数值
性别[例(%)]  
男性 27(43.5)
女性 35(56.5)
年龄(岁,±s) 65.8±13.7
贫血[例(%)]a 17(27.4)
体重指数(kg/m2,±s) 24.2±3.7
GerdQ评分(分,±s) 8.6±2.1
疝类型[例(%)]  
原发疝 50(80.6)
复发疝 12(19.4)
ASA分级[例(%)]  
Ⅰ 31(50.0)
Ⅱ 28(45.2)
Ⅲ 3(4.8)
症状[例(%)]  
烧心 23(37.2)
反流 45(72.6)
胸痛 11(17.7)
咳嗽 2(3.2)
吞咽困难 5(8.1)
胃镜LA分级[例(%)]  
未见食管炎 33(53.2)
Grade A 16(25.8)
Grade B 6(9.7)
Grade C 3(4.8)
Grade D 3(4.8)
Barrett食管炎 1(1.6)
表2 腹腔镜合成补片修补Ⅲ型食管裂孔疝围手术期相关指标分析（n=62）
项目 数值
手术类型[例(%)]  
择期 62(100.0)
急诊 0(0.0)
手术入路[例(%)]  
腹腔镜 62(100.0)
中转开放 0(0.0)
折叠类型[例(%)]  
Nissen 56(90.3)
Toupet 3(4.8)
未做折叠 3(4.8)
手术时间(min,±s) 114.5±35.7
裂孔大小(cm,±s) 4.3±1.7
裂孔≥4 cm[例(%)] 49(79.0)
膈肌脚缝合针数(±s) 4.0±1.7
折叠袢缝合针数(±s) 2.8±1.3
术后住院时间[M(IQR)] 5.0(4.0, 6.0)
术中及短期并发症[例(%)]  
胸膜损伤 18(29.0)
出血二次手术后死亡 1(1.6)
胸腔积液穿刺 1(1.6)
30天内再入院 1(1.6)
表3 单因素Logistic回归分析复发、术后吞咽困难的影响因素
变量 复发 吞咽困难
OR 95% CI P值 OR 95% CI P值
体重指数 0.937 0.736~1.192 0.595 0.981 0.815~1.180 0.835
年龄 1.009 0.946~1.076 0.792 0.954 0.909~1.001 0.053
食管裂孔大小 0.491 0.151~1.593 0.236 1.114 0.559~2.221 0.760
原发/复发 5.222 0.906~30.112 0.064 1.050 0.193~5.725 0.955
膈肌脚缝合针数 0.462 0.208~1.027 0.058 1.039 0.598~1.807 0.891
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