腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效

目的探讨腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝（HH）合并胃食管反流病患者的临床疗效。 方法选择2016年1月至2019年1月河北北方学院附属第二医院收治的108例食管裂孔疝合并胃食管反流病患者开展回顾性研究，按照不同手术方式将患者分为2组，每组患者54例。对照组行常规开腹手术，联合组行腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术，比较2组患者术前及术后6个月反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分。 结果2组术前反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异无统计学意义（P>0.05）；2组患者术后6个月反流症状与术前比较，均得到明显改善，差异有统计学意义（P<0.05）；2组术后反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异有统计学意义（P<0.05）。联合组患者的手术时间、术中出血量及术后住院时长均明显优于对照组，差异有统计学意义（P<0.05）。 结论腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术对HH合并胃食管反流病患者效果显著，有利于患者身体快速恢复，微创、安全且近期疗效满意。

Clinical efficacy of laparoscopic repair of esophageal hiatal hernia combined with modified DOR fundoplication in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease

ObjectiveTo investigate the clinical effect of laparoscopic repair of esophageal hiatal hernia combined with modified DOR fundoplication in the treatment of esophageal hiatal hernia complicated with gastroesophageal reflux disease. Methods108 patients with esophageal hiatal hernia complicated with gastroesophageal reflux disease treated in the Second Affiliated Hospital of Hebei North University from January 2016 to January 2019 were selected for retrospective study. The patients were divided into two groups according to different surgical methods, with 54 patients in each group. The control group received routine open surgery, and the combined group received laparoscopic hiatal hernia (HH) repair combined with modified DOR fundoplication. The reflux time, reflux times, DeMeester score, lower esophageal sphincter pressure and Gerd Q scale score before and 6 months after operation were compared between the two groups. ResultsThere was no significant difference in preoperative reflux time, reflux times, DeMeester score, lower esophageal sphincter pressure and Gerd Q scale between the two groups (P>0.05). The reflux symptoms of the two groups were significantly improved 6 months after operation compared with those before operation (P<0.05). There were significant differences in postoperative reflux time, reflux times, DeMeester score, lower esophageal sphincter pressure and Gerd Q scale between the two groups (P<0.05). The operation time, intraoperative bleeding and postoperative hospital stay in the combined group were significantly better than those in the control group (P<0.05). ConclusionLaparoscopic HH repair combined with modified DOR fundoplication is effective in patients with HH complicated with gastroesophageal reflux disease, which is conducive to rapid recovery, minimally invasive, safe and has satisfactory short-term efficacy.