腹腔镜手术治疗婴幼儿食管裂孔疝的探讨

目的 探讨腹腔镜手术治疗婴幼儿食管裂孔疝的安全性和疗效.方法 2001年9月至2010年1月对34例婴幼儿食管裂孔疝患儿施行食管裂孔修补Nissen胃底折叠术.其中3例产前超声诊为"膈疝",术前造影1例合并肠旋转不良同时在腹腔镜下行Ladd's手术,1例合并胃排空延迟同时在腹腔镜下完成幽门成形术,1例合并右侧腹股沟斜疝同时在腹腔镜下完成疝囊高位结扎手术.结果 34例中1例中转开腹,其余33例均在腹腔镜下完成食管裂孔修补Nissen胃底折叠术.年龄最小2 h,手术时间平均122min(100～210min);术中出血量平均5ml(1～10ml);术后24～48 h进奶,术后住院4～12 d,平均6.5 d.26例术后随访1个月～6年,1例术后6 d出现呕吐,给予胃动力药物(吗丁啉)治疗后好转;2例患儿于术后1年及1年半复发,均再次行腹腔镜食管裂孔修补术治愈;其余生长发育正常,无明显并发症发生.结论 本研究证实了腹腔镜手术治疗婴幼儿食管裂孔疝具有明显优势,创伤小,疗效确切,可以联合治疗其他疾病,不会造成脏器粘连,对复发病例二次手术时仍可采用腹腔镜技术;即使食管旁疝和混合疝无症状也应早期手术.术者应具备新生儿手术经验及熟练的腔镜操作基础.

Laparoscopic repair of hiatus hernia in infants

Objective To investigate the safety and efficacy of the laparoscopic repair of hiatus hernia in infants. Methods Esophageal hiatus repair and Nissen fundoplication was performed in 34 infants with hiatal hernia during September 2001 to January 2010. Three cases were diagnosed as "diaphragmatic hernia "by prenatal ultrasonography at 27 weeks, 32 weeks, and 38 weeks gestational age,respectively. Their diagnoses were confirmed by gastrointestinal contrast radiography after birth. One of the three patients, whose gastrointestinal contrast radiography showed the signs of paraesophageal hernia, volvulus of stomach and gastroesophageal reflux, were performed laparoscopic repair 22 hours later after birth. Some patients underwent extra operations for other problems complicated with hiatus hernia: 1 patient underwent laparoscopic Ladds operation for intestinal malrotation; 1 underwent laparoscopic pyloroplasty for delayed gastric emptying; and 1 had laparoscopic hernia sac ligation for right inguinal hernia. Results The patients were successfully performed laparoscopic esophageal hiatus repair and Nissen fundoplication except 1 converted to open surgery. The youngest patient was only 2 hours after birth. The mean operation time was 122 min (100 min～210 min). The mean blood loss was 5ml (1～10 ml). Feeding started at 24～48 h after surgery. The average postoperative hospital stay was 6. 5 days (4～12days). Twenty six patients were followed up from 1 month to 6 years. One patient vomited in the 6th day after operation, and was improved after gastric motility medicine treatment (Domperidore). The recurrence of hiatus hernia was found in 2 patients at 1 and 1.5 years after operation, and cured after the second laparoscopic hiatus hernia repair. Conclusions Laparoscopic repair for infant hiatus hernia is safe and effective.