腔镜手术治疗儿童食管裂孔疝的临床体会(附104例报告)

目的:探讨腹腔镜下儿童食管裂孔疝的治疗经验与体会。方法:回顾分析2002年6月至2016年12月为104例食管裂孔疝患儿行腹腔镜手术的临床资料。患儿50 d~10岁,平均(4.0±1.5)岁。按美国消化内镜学会分类:滑动性疝25例、混合性疝42例、食管旁疝37例,术前均通过上消化道造影明确食管裂孔疝。采用5孔法施术,行Nissen-Rossetti、改良Thal法修补食管裂孔并进行胃底折叠。结果:腹腔镜手术均顺利完成,无一例中转开腹。疝孔直径3~5 cm,手术时间90~150 min,平均(110±20)min;术后5例复发。其中4例再次通过腹腔镜进行修补。改良Thal法术后发生胃食管反流4例,术后1例发生裂孔关闭过紧,再次腔镜下松解裂孔。本组术后24~48 h正常进食,平均(28±4)h;术后5~7 d出院。随访3个月~13年,患儿均生长发育良好。结论:腹腔镜下治疗儿童食管裂孔疝具有良好的手术效果,术者必须具备较高的腔镜技术,术前患儿的评估对手术方法的选择与预后具有重要作用。

The laparoscopic treatment of hiatal hernia for children:with a report of 104 cases

Objective:To investigate the experience of laparoscopic treatment of hiatal hernia for children .Methods:A retro-spective analysis was made on the clinical data of 104 children who suffered from hiatal hernia and underwent laparoscopic operation be -tween Jun.2002 and Dec.2016.The age ranged from 50 d to 10 years,the average was (4.0 ±1.5) years.Based on American Society for Gastrointestinal Endoscopy ,there were 25 cases of slide hernia ,42 cases of mixed hiatal hernia ,and 37 cases of paraesophageal her-nia.The upper gastrointestinal contrast was done to everybody for the diagnosis .Five-port method was used for Nissen-Rossetti,modified Thal repair of esophageal hiatus and fundoplication .Results:All laparoscopic operations were successful without conversion to open pro-cedure.The diameter of the defect was from 3 to 5 cm.The mean operative time was (110 ±20) min (range,90-150 min).Five pa-tients suffered from recurrence ,and 4 underwent laparoscopic repair .Four patients with modified Thal repair suffered from gastroesopha-geal reflux ,one hernia was sutured too tight and loosened in re-laparoscopy .The children took normal diet in 24 to 48 h after operation , the mean time was (28 ±4) h.The postoperative hospital stay was 5-7 d.Patients were followed-up for 3 months to 13 years,and all well developed .Conclusions:Laparoscopic operation is an effective treatment for pediatric hiatal hernia .The operators must have better laparoscopic skill ,the preoperative evaluation of patients is important for the choice of operative method and prognosis .