CAJ | 학술논문

目的探讨腹腔镜食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝疾病的可行性和临床应用价值.方法回顾性分析了潍坊市人民医院于2010年9月~2012年6月采用腹腔镜技术治疗的65例食管裂孔疝患者资料.其中 Nissen 全360°胃底折叠术24例,Toupet270°胃底折叠术20例,Dor 前180°胃底折叠术21例,52例应用补片修补裂孔,剩余患者丝线缝合裂孔.结果手术顺利,无中转开腹者.术后随访3~20个月,手术效果满意率92.31%,术后3个月复查胃镜、上消化道造影等检查基本恢复正常.其中11例患者术后早期出现轻度反酸、烧心症状,6例4个月内自行缓解,3例出现吞咽困难(Nissen 组2例,Toupet 组1例),1例出现严重反酸、腹胀(Dor 组),1例疝复发(Dor 组,单纯丝线缝合裂孔).结论腹腔镜食管裂孔疝修补和胃底折叠术治疗食管裂孔疝疾病有微创手术创伤小、恢复快、安全可行、疗效可靠等特点,胃底折叠术式根据病人具体情况应用.
목적탐토복강경식관렬공산수보연합위저절첩술치료식관렬공산질병적가행성화림상응용개치.방법회고성분석료유방시인민의원우2010년9월~2012년6월채용복강경기술치료적65례식관렬공산환자자료.기중 Nissen 전360°위저절첩술24례,Toupet270°위저절첩술20례,Dor 전180°위저절첩술21례,52례응용보편수보렬공,잉여환자사선봉합렬공.결과수술순리,무중전개복자.술후수방3~20개월,수술효과만의솔92.31%,술후3개월복사위경、상소화도조영등검사기본회복정상.기중11례환자술후조기출현경도반산、소심증상,6례4개월내자행완해,3례출현탄인곤난(Nissen 조2례,Toupet 조1례),1례출현엄중반산、복창(Dor 조),1례산복발(Dor 조,단순사선봉합렬공).결론복강경식관렬공산수보화위저절첩술치료식관렬공산질병유미창수술창상소、회복쾌、안전가행、료효가고등특점,위저절첩술식근거병인구체정황응용.
@@@@Objective To explore the feasibility and clinical value of laparoscopic hiatal hernia repair and fundoplication for the treatment of esophageal hiatal hernia .Methods The clinical data of 65 patients who underwent laparoscopic surgery for esophageal hiatal hernia from September 2010 to June 2012 at our hospital were retrospectively analyzed ,including 24 cases of Nissen fundoplication,20 Toupet fundoplication,and 21 anterior 180 degrees partial fundoplication .Results All operations were performed smoothly ,no conversions were nee-ded.After the follow up period of 3 months ~20 months,the satisfaction rate of operation was 92.31%.The symptoms in most cases were ade-quately relieved after operation.Endoscopy,radiology were repeated 3 months after surgery.Eleven cases had mild symptom recurrence of acid reflux,6 cases relieved within 4 months,developed dysphagia occurred in 3 cases(2 in the Nissen group and 1 in the Dor group),1 case had severly acid reflux and distention(Dor group),and hital hernia recurrence occurred in 1 case(Dor group).Conclusion Laparoscopic repair of esophageal hiatal hernia and fundoplication has the following advantages :minimized trauma,quick recovery,Safe and reliable effect proce-dures for hiatal hernia.Fundoplication can be choose according to the conditions of the patient .