CAJ | 학술논문

目的探讨婴儿经胸同期行Nissen手术治疗混合型食管裂孔疝并观察临床效果.方法应用左侧经胸入路行食管裂孔疝修补附加Nissen手术抗胃食管反流手术治疗婴儿混合型食管裂孔疝18例,其中合并肥厚性幽门梗阻1例、肠旋转不良2例,全组病例均有不同程度的贫血、消瘦、发育迟缓表现.手术依次完成食管松解、疝囊切除、幽门探查、胃底折叠、食管裂孔修补步骤,1例合并肥厚性幽门梗阻加行幽门成形术.结果 18例均顺利完成手术,平均手术1.5h,平均术中失血量5ml,平均重症监护21.5h,平均住院15天,平均随访22个月.无术后肺部并发症,无疝复发,1例术后6个月上消化道造影发现中-重度胃食管反流,经予胃动力药物及抗酸药物治疗后反流变为轻-中度.结论经胸同期行Nissen手术治疗婴儿混合型食管裂孔疝是安全有效的手术方式,具备充分游离松解食管、膈肌脚识别准确、Nissen手术操作方便等优势.
목적 탐토영인경흉동기행Nissen수술치료혼합형식관렬공산병관찰림상효과.방법 응용좌측경흉입로행식관렬공산수보부가Nissen수술항위식관반류수술치료영인혼합형식관렬공산18례,기중합병비후성유문경조1례、장선전불량2례,전조병례균유불동정도적빈혈、소수、발육지완표현.수술의차완성식관송해、산낭절제、유문탐사、위저절첩、식관렬공수보보취,1례합병비후성유문경조가행유문성형술.결과 18례균순리완성수술,평균수술1.5h,평균술중실혈량5ml,평균중증감호21.5h,평균주원15천,평균수방22개월.무술후폐부병발증,무산복발,1례술후6개월상소화도조영발현중-중도위식관반류,경여위동력약물급항산약물치료후반류변위경-중도.결론 경흉동기행Nissen수술치료영인혼합형식관렬공산시안전유효적수술방식,구비충분유리송해식관、격기각식별준학、Nissen수술조작방편등우세.
Objective The aim of this study was to evaluate the left transthoracic approach in simultaneous antireflux surgery at the time of CDH repair in Infancy.Methods Between June 2008 and June 2012,18 patients underwent a left transthoracic approach in the treatment of type Ⅲ and Ⅳ hiatal hernia.,including 1 gastric volvulus.Clinical presentation in these patients included vomiting(n =12) 、pulmonary infections (n =9)、symptomatic anemia、failure to thrive (n =18).All the patients were evaluated before and after the surgery on clinical presentation,symptoms and functional assessment.Surgical techniques included extensive mediastinal esophageal dissection,Nissen fundoplication,resection of the hernial sac,crural closure.Results The average of operative time was 90 minutes.The mean blood loss was 5 ml.The average length of stay was 15 days.The hours stayed in PICU were 21.5 h.Mean follow-up was 22 months.There was no hospital mortality and hernia recurrence.Only one patient suffered gastroesophageal reflux disease after operation,and was controlled with antireflux medications.Conclusion Transthoracic is the optimal operative approach for treating the esophageal hiatal hernia,with relatively low postoperative morbidity and recurrence rates.Advantages of the transthoracic approach include the facilitation of Nissen fundoplication、esophageal lengthening procedures,and excellent exposure for the crural suturing.