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目的回顾性分析腹腔镜下食管裂孔疝修补术的临床手术效果。方法回顾2013年1月—2015年12月收治的38例食管裂孔疝患者的临床资料,其中21例行腹腔镜手术(腹腔镜组),17例行开腹手术(开腹手术组),所有患者均采用食管裂孔疝专用补片修补并加固食管裂孔,缝合膈肌脚,术中行胃底折叠术抗反流(Nissen胃底折叠术)或改良术式。对比分析两组患者情况。结果所有患者手术均顺利完成。腹腔镜组手术时间平均(110±5)min,术中出血量平均(70±6)m L,术后住院时间平均(8±2)d;开腹手术组手术时间平均(150±6)min,术中出血量平均(150±10)m L,术后住院时间平均(12±2)d;两组比较差异有统计学意义(P<0.05)。两组患者随访3~36个月,平均(20±3)个月,术后主要症状均得到缓解。腹腔镜组术后仍有术前不适症状2例,烧心反酸1例,胸骨后疼痛1例。开腹手术组复发1例,胸骨后疼痛不适4例,反酸3例。结论腹腔镜下食管裂孔疝修补术相对开腹手术具有手术时间短、术中出血量少及并发症少等优点,值得临床推广应用。
Objective To retrospectively analyze the clinical effect of laparoscopic esophageal hiatal hernia repair. Methods The clinical data of 38 patients with esophageal hiatal hernia admitted between January 2013 and December 2015 were retrospectively reviewed. Among them, 21 patients underwent laparoscopic surgery (laparoscopic group) and 17 underwent laparotomy (open surgery group) Patients were treated with esophageal hernia special patch to repair and strengthen the esophageal hiatus, suture the diaphragm feet, intraoperative fundoplication antireflux (Nissen fundoplication) or modified operation. Comparative analysis of two groups of patients. Results All patients underwent surgery successfully. The average operation time was (110 ± 5) min in laparoscopic group, the average amount of bleeding was (70 ± 6) m L and the average postoperative hospital stay was (8 ± 2) days. The average operative time was 150 ± 6 in open surgery group min. The average amount of blood loss during operation was (150 ± 10) m L and the average postoperative hospital stay was (12 ± 2) days. There was significant difference between the two groups (P <0.05). The two groups were followed up for 3 to 36 months, with an average of (20 ± 3) months, the main symptoms were relieved. In laparoscopic group, there were still 2 cases of preoperative symptoms, 1 case of heartburn and 1 case of retrosternal pain. One patient had recurrent laparotomy, 4 had pain and discomfort after sternum, and 3 had acid reflux. Conclusion laparoscopic esophageal hiatal hernia repair relative laparotomy with shorter operation time, less blood loss and fewer complications, it is worthy of clinical application.