【摘要】 目的探讨全腹腔镜食管裂孔修补+Nissen胃底折叠新技巧治疗食管裂孔疝的可行性及安全性。方法行全腹腔镜食管裂孔修补术食管裂孔疝患者96例,对照组40例,行常规Nissen胃底折叠;Nissen改进组56例,以可弯曲腔镜直线切割缝合器置于胃前壁作为支撑再行Nissen胃底折叠。结果两组患者均顺利完成手术,无围手术期死亡。Nissen改进组1例患者术后出现伤口脂肪液化,两组患者无严重手术并发症。术后6个月两组均无复发患者,对照组和Nissen改进组Demeester评分分别为(11.48±3.74)分和(12.86±4.45)分,均降至正常范围,且两组间比较差异无统计学意义(P>0.05)。Nissen改进组术后胃食管返流疾病相关生活质量量表评分为(2.3±1.2)分,对照组为(4.2±1.8)分,两组比较差异有统计学意义(P<0.01)。Nissen改进组,术后吞咽困难发生率和严重度评分为8.9%和(1.4±0.5)分,对照组分别为27.5%和(2.9±1.0)分,两组比较差异有统计学意义(P<0.01),两组腹胀发生率分别为7.1%和15.0%(P>0.05),但Nissen改进组程度更轻[(1.3±0.5)分和(2.7±1.0)分,P<0.05]。术后6个月Nissen改进组整体生活质量满意度高于对照组(96.4%和82.5%,P<0.05)。结论全腹腔镜食管裂孔修补+Nissen胃底折叠新技巧治疗食管裂孔疝安全有效,术后吞咽困难及腹胀发生率低。更多还原

【Abstract】 Objective To study the feasibility and safety of totally laparoscopic hiatal hernia repair and a new technique of Nissen fundoplication.Methods A total of 96 patients with hiatal hernia were treated by laparoscopic surgery.After the repair of hiatal hernia,40 patients received routine Nissen fundoplication with no support adhered to the front wall of stomach(control group),and the others were treated by a modified Nissen fundoplication in which a flexible linear cut stapler was put against to the front wall of stomach when performing Nissen fundoplication(modified Nissen group).Results The clinical characteristics and operation data were similar between the two groups(P > 0.05).All patients accomplished the operation successfully with no perioperative death.One patient in modified Nissen group developed fat liquefication after operation and no severe complication were found in both groups.After six months,no recurrence of hiatal hernia was found in both groups,the Demeester score of control group and modified Nissen group were both fallen to the normal range and no statistical difference was found between the two groups[(11.48 ±3.74)vs(12.86 ±4.45),P=0.107].however,the score of Gastroesophageal Reflux Disease-Health Related Quality of Life(GERD-HRLQ) in modified Nissen group(2.3 ±1.2) was significantly lower than that of the control group(4.2 ± 1.8,P=0.002).The incidence and the severity score of dysphagia after surgery in modified Nissen group were both significantly lower than those in the controlgroup(8.9%vs 27.5%,P = 0.016;1.4 ±0.5 vs 2.9 ± 1.0,P =0.009).while the incidence of bloating was similar between the two groups(7.1%vs 15.0%,P =0.366),modified Nissen group owned much lower severity score of bloating[(1.3 ± 0.5) vs(2.7 ± 1.0),P = 0.036].Patients’ postoperative satisfaction rate of quality of life in modified Nissen group(96.4%) was also found to be significantly higher than that in control group(82.5%,P = 0.032).Conclusion Totally laparoscopic esophageal hiatal hernia repair and modified Nissen fundoplication are safe and effective for hiatal hernia with a low incidence of postoperative dysphagia and bloating.更多还原