腹腔镜手术治疗小儿食管裂孔疝的效果分析

目的 探讨腔镜下食管裂孔疝修补+Nissen胃底折叠术治疗小儿食管裂孔疝的可行性及临床疗效。方法 回顾性分析2007年3月—2020年3月南京医科大学附属儿童医院小儿胸心外科收治的57例食管裂孔疝患儿的临床资料,其中男35例、女22例,年龄为2~97(17±4.17)个月。依据解剖分型标准,Ⅰ型46例,Ⅱ型7例,Ⅲ型4例。采用腹部五孔法行腹腔镜食管裂孔疝修补+Nissen胃底折叠术。记录手术时间、术中出血量、住院时间。观察患儿术后临床症状恢复情况,有无吞咽困难、呕吐、反酸、腹胀、便血、切口感染等并发症,以及术后复发情况。结果 57例患儿中,1例中转开腹手术,其余患儿均顺利完成腹腔镜手术。腔镜手术时间93~176(129±33)min,术中出血量8~15 mL,患儿住院时间9~14(11±2.3)d。手术后出现严重腹胀2例,经保守治疗痊愈;术后复发1例,再次腹腔镜手术后痊愈。患儿贫血、上消化道及呼吸道症状较前明显改善,无切口感染、吞咽困难、食管反流等并发症的发生。54例患儿获随访,随访时间1个月~8年,平均17个月。随访期间患儿体重增加,术前消化道症状消失,生长发育良好。结论 腹腔镜下食管裂孔疝修补术+Nissen胃底折叠术治疗小儿食管裂孔疝,具有创伤性小、疗效确切、手术视野清楚、手术时间短、术后恢复快、术后并发症发生率低等优点,是一种安全可靠、治疗效果好的微创手术方法。

Analysis of the effect of laparoscopic surgery on children with hiatal esophageal hernia

Objective To explore the feasibility, safety, surgical method, and therapeutic effect of the laparoscopic treatment of esophageal hiatal hernia in children.Methods Clinical data of 57 children with esophageal hiatal hernia in the Department of Pediatric Thoracic Surgery, Children's Hospital of Nanjing Medical University from March 2007 to March 2020 were retrospectively analyzed, including 35 males and 22 females, aged 2-97 (17±4.17) months. The anatomical classification was as follows: Type I 46 cases, TypeⅡ 7 cases, and Type Ⅲ 4 cases. All the children underwent upper gastrointestinal angiography to confirm the diagnosis further. One case was converted to laparotomy during operation, and other children completed the operation under laparoscopy and Nissen fundoplication. Operative time, intraoperative blood loss, and length of hospital stay were recorded, and the recovery of clinical symptoms including dysphagia, vomiting, acid reflux, abdominal distension, hematochezia, incision infection, and postoperative recurrence was observed.Results A total of 57 children completed the operation under laparoscopy and Nissen fundoplication, and one case was converted to laparotomy. The operative time was 93-176 (129±33.6) min, hospital stay was 9-14 (11±2.3) days, and mean blood loss was 8-15 mL. Two cases of severe abdominal distension were cured by conservative treatment after operation. One case of recurrence was treated by laparoscopic surgery. Gastrointestinal and respiratory symptoms were substantially improved postoperatively. Incision infection, dysphagia, and esophageal reflux were not observed. The follow-up period was from January to 8 years, and the follow-up average was 17 months. All the others remained symptom-free and well developed, and body weight increased.Conclusions The treatment of laparoscopic and Nissen fundoplication for hiatal hernia has the advantages of less trauma, definite curative effect, clear surgical vision, short operation time, quick postoperative recovery, and low postoperative complications. Total laparoscopic surgery for hiatal hernia is a safe, reliable, and effective minimally invasive surgery method.