中华疝和腹壁外科杂志（电子版）
中華疝和腹壁外科雜誌（電子版）
중화산화복벽외과잡지（전자판）
CHINESE JOURNAL OF HERNIA AND ABDOMINAL WALL SURGERY(ELECTRONIC VERSION)
2014年
5期
396-402
,共7页
胡志伟%汪忠镐%吴继敏%梁伟涛%张玉%王峰%马松松%纪涛%田书瑞%田鑫帅%许辉%梁艳
鬍誌偉%汪忠鎬%吳繼敏%樑偉濤%張玉%王峰%馬鬆鬆%紀濤%田書瑞%田鑫帥%許輝%樑豔
호지위%왕충호%오계민%량위도%장옥%왕봉%마송송%기도%전서서%전흠수%허휘%량염
疝,食管裂孔%胃食管反流%哮喘%疝修补术%胃底折叠术
疝,食管裂孔%胃食管反流%哮喘%疝脩補術%胃底摺疊術
산,식관렬공%위식관반류%효천%산수보술%위저절첩술
Hernia,hiatal%Gastroesophageal reflux%Asthma%Herniorrhaphy%Fundoplication
目的：探讨腹腔镜食管裂孔疝（hiatal hernia，HH）修补术加胃底折叠术对胃食管反流病（gastroesophageal reflux disease，GERD）合并HH及哮喘症状的疗效。方法收集2008年1月至2012年1月第二炮兵总医院收治的GERD合并HH患者。问卷随访和评价术前及术后胃食管反流病典型症状和哮喘症状评分和并发症。结果共纳入和成功随访476例，其中Ⅰ、Ⅱ、Ⅲ、Ⅵ型HH分别占90．8％、1．1％、5．9％和2．3％。补片植入56例，Nissen 和 Toupet 胃底折叠术分别为310例和166例。平均随访（4．4±1．3）年，术后无严重并发症和死亡。手术总有效率为95．5％，胃食管反流典型症状评分和哮喘症状评分分别从（13．4±2．0）和（18．2±2．9）下降至（3．1±1．7）和（5．2±5．0），差异均有统计学意义（t＝11．7、14．4，P均＜0．001），术后症状评分缓解率分别为76．9％和71．4％。结论腹腔镜下HH修补术加胃底折叠术能有效控制GERD的典型症状及哮喘症状，并且安全性良好。胃食管反流、食管裂孔疝和哮喘三者之间存在相关性，值得进一步的探讨和研究。
目的：探討腹腔鏡食管裂孔疝（hiatal hernia，HH）脩補術加胃底摺疊術對胃食管反流病（gastroesophageal reflux disease，GERD）閤併HH及哮喘癥狀的療效。方法收集2008年1月至2012年1月第二砲兵總醫院收治的GERD閤併HH患者。問捲隨訪和評價術前及術後胃食管反流病典型癥狀和哮喘癥狀評分和併髮癥。結果共納入和成功隨訪476例，其中Ⅰ、Ⅱ、Ⅲ、Ⅵ型HH分彆佔90．8％、1．1％、5．9％和2．3％。補片植入56例，Nissen 和 Toupet 胃底摺疊術分彆為310例和166例。平均隨訪（4．4±1．3）年，術後無嚴重併髮癥和死亡。手術總有效率為95．5％，胃食管反流典型癥狀評分和哮喘癥狀評分分彆從（13．4±2．0）和（18．2±2．9）下降至（3．1±1．7）和（5．2±5．0），差異均有統計學意義（t＝11．7、14．4，P均＜0．001），術後癥狀評分緩解率分彆為76．9％和71．4％。結論腹腔鏡下HH脩補術加胃底摺疊術能有效控製GERD的典型癥狀及哮喘癥狀，併且安全性良好。胃食管反流、食管裂孔疝和哮喘三者之間存在相關性，值得進一步的探討和研究。
목적：탐토복강경식관렬공산（hiatal hernia，HH）수보술가위저절첩술대위식관반류병（gastroesophageal reflux disease，GERD）합병HH급효천증상적료효。방법수집2008년1월지2012년1월제이포병총의원수치적GERD합병HH환자。문권수방화평개술전급술후위식관반류병전형증상화효천증상평분화병발증。결과공납입화성공수방476례，기중Ⅰ、Ⅱ、Ⅲ、Ⅵ형HH분별점90．8％、1．1％、5．9％화2．3％。보편식입56례，Nissen 화 Toupet 위저절첩술분별위310례화166례。평균수방（4．4±1．3）년，술후무엄중병발증화사망。수술총유효솔위95．5％，위식관반류전형증상평분화효천증상평분분별종（13．4±2．0）화（18．2±2．9）하강지（3．1±1．7）화（5．2±5．0），차이균유통계학의의（t＝11．7、14．4，P균＜0．001），술후증상평분완해솔분별위76．9％화71．4％。결론복강경하HH수보술가위저절첩술능유효공제GERD적전형증상급효천증상，병차안전성량호。위식관반류、식관렬공산화효천삼자지간존재상관성，치득진일보적탐토화연구。
Objective To investigate the outcome of laparoscopic hiatal hernia (HH ) repair/fundoplication for gastroesophageal reflux disease (GERD)complicated with HH and asthmatic symptoms. Methods GERD patients complicated with HH and asthmatic symptoms treated in the Second Artillery General Hospital of PLA from January 2008 to January 201 2 were documented.The outcomes were followed up with a questionnaire to assess the symptom scores of the typical GERD symptoms,asthmatic symptoms and complications before and after surgery. Results 476 patients were included and followed up successfully,with type I,Ⅱ,Ⅲ and Ⅵ HH in 90.8%,1 .1%,5.9% and 2.3% of the cases.HH repaired with mesh in 56 cases;Nissen and Toupet fundoplication were performed in 31 0 and 1 66 cases respectively.The mean follow-up duration was (4.4 ±1 .3 ) years.No severe complication or death occurred.The overall improvement rate was 95 .5%.The symptom scores for typical GERD symptom and asthmatic symptom significantly decreased from (13.4 ±2.0)and(18.2 ±2.9)to (3.1 ±1.7)and (5.2 ±5.0),with 76.9%and 71 .4%of symptom score reduction rate respectively after surgery (t=1 1 .7, 1 4.4,P <0.001 ).Conclusions The laparoscopic HH repair/fundoplication is safe and effective for GERD typical symptoms as well as asthmatic symptoms for GERD patients complicated with HH and asthmatic symptoms.Further investigation will be necessary to elucidate the relationship between GERD,HH and asthma.
