食管裂孔疝合并胃食管反流病合并胃间质细胞瘤的外科治疗

目的探讨食管裂孔疝合并胃食管反流病合并胃间质细胞瘤患者的围手术期处理及安全性。 方法统计新疆维吾尔自治区人民医院2012年10月至2015年1月收治的17例食管裂孔疝合并胃食管反流病合并胃间质细胞瘤患者的病案资料，均采用腹腔镜下微创手术，其中单纯食管裂孔疝缝合者13例，生物补片修补者3例，强生PHY补片修补者1例。抗反流术式中行Nissen式胃底折叠术者8例，Dor式胃底折叠术者6例，Toupet式胃底折叠术者3例。病理结果提示极低危险度胃间质细胞瘤8例，低度危险度者4例，中度危险度者3例，高度危险度者1例，极高危险度者1例，回顾性总结分析该类患者围手术期的处理措施。 结果本组患者无围手术期死亡，术后无严重并发症发生，术后患者反流症状均较术前明显改善，反流时间、反流次数、酸反流时间百分比、长反流次数及DeMeester评分较术前明显降低(P<0.05)，术后GERD Q量表评分较术前明显减低(P<0.05)；LES压力较术前明显提高(P<0.05)。术后切口感染1例，慢性疼痛1例，给予换药、理疗后好转。2例患者术后出现进食哽噎，1例患者术后出现腹泻，嘱其少量多餐、细嚼慢咽，1个月后症状消失。合并贫血患者术后血红蛋白恢复至95 g/L，术后随访中位数10个月，无复发病例。 结论食管裂孔疝合并胃食管反流病合并胃间质细胞瘤患者病情较复杂使得手术风险大，难度高，但只要作好充分的术前准备，采用恰当的手术方式，术中谨慎、细致操作，针对性的处理术后出现的各种问题，仍是安全可行的。

Surgical treatment of hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors

ObjectiveTo investigate the perioperative management and safety of the patients who had hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors. MethodsStatistics the medical record information of 17 patients who had hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors in Xinjiang Uygur Autonomous Region People′s Hospital from October 2012 to January 2015.All of them were adopted laparoscopic minimally invasive surgery, 13 cases were adopted pure hiatal hernia suture, 3 cases were used biological patch repair, 1 case used Johnson PHY patch repair.In anti reflux surgery there were 8 patients underwent Nissen fundoplication, 6 cases underwent Dor fundoplicationand and 3 cases underwent Toupet fundoplication.Pathology results suggest that among very low risk of gastric stromal tumor in 8 cases, low risk in 4 cases, 3 cases of moderate risk, 1 case of high risk and 1 case of very high risk, Retrospectively analyzed these patients perioperative treatment measures. ResultsThis group of patients has no perioperative death, no serious postoperative complications.The reflux symptoms were significantly improved postoperative, There is significantly lower than the preoperative in reflux time, the number of reflux, acid reflux time percentage, long reflux episodes and DeMeester score(P<0.05). GERD Q scale score was significantly lower than the preoperative(P<0.05). LES pressure significantly increased compared with preoperative(P<0.05). There were 1 patient had wound infection postoperative, 1 patient had chronic pain, both of them recovered after administering medication and physiotherapy.2 patients had postoperative eating choked, 1 patient suffered from diarrheathe, symptoms disappeared after 1 month by nursing them smaller meals and eat slowly.The hemoglobin in the patients combined preoperative anemic recovered to 95 g/L after the surgery.None of them recurred after 10 months′follow-up. ConclusionThe surgery risky was high and the operative would be more difficult with the complex condition which the patients had hiatal hernia combined with gastroesophageal reflux disease and gastrointestinal stromal tumors.However, it is still safe and feasible with adequate preoperative preparation, appropriate surgical methods, careful and meticulous operation and targeted treatment of postoperative various problems.