腹腔镜下食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝及长期疗效的评估

目的观察分析腹腔镜下食管裂孔疝修补联合Nissen/Dor胃底折叠术治疗食管裂孔疝临床疗效及食管测压与pH值监测对长期疗效的预估意义。 方法回顾性分析2018年1月至2020年1月于河北北方学院附属第二医院收治的120例食管裂孔疝患者的临床资料,其中64例行腹腔镜下食管裂孔疝修补联合Nissen胃底折叠术（Nissen组）,56例行腹腔镜下食管裂孔疝修补联合Dor胃底折叠术（Dor组）。术后随访1年,对比观察2组患者手术情况、住院时间、术后并发症、记录食管测压及pH检测等指标变化情况、Gerd Q、DeMeester评分等。 结果Nissen组术程以及术中出血量明显高于Dor组（P<0.05）,2组总住院时间差异无统计学意义（P>0.05）。2组患者术后总并发症发生率比较,差异无统计学意义（P>0.05）;2组患者术后1年食管反流情况与DeMeester评分较术前均得到明显改善。Nissen组在减少反流次数、长反流次数和最长反流时间方面均优于Dor组（P<0.05）。2组在反流时间、酸反流时间百分比与DeMeester评分比较,差异均无统计学意义（P>0.05）;术后2组患者食管下括约肌压力、静息呼吸平均值、食管残余压较术前均显著提升（P<0.05）,但2组间术后比较无明显差异（P>0.05）。术后2组患者食管松弛率、无效吞咽与Gerd Q评分均较术前也均明显降低,但2组间差异无统计学意义（P>0.05）。 结论腹腔镜疝修补术联合Nissen或Dor胃底折叠术治疗食管裂孔疝均有明显效果,临床应根据患者自身情况选择合适的手术方式。     

Bougie管支撑下腹腔镜Nissen胃底折叠术治疗食管裂孔疝合并胃食管反流临床效果分析

目的 探讨Bougie管支撑下行腹腔镜Nissen胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床效果。方法 回顾性分析2017年10月至2021年10月我科手术治疗的70例食管裂孔疝合并胃食管反流患者的临床资料，按手术方式分为两组，分别行腹腔镜食管裂孔疝修补+Nissen胃底折叠术(Nissen组，35例)和腹腔镜食管裂孔疝修补+Bougie管支撑下胃底Nissen折叠术(Bougie组，35例)。比较两组患者围术期指标、术后1月内并发症发生率及术后半年胃食管反流指标。结果 Bougie组手术时间、术后恢复饮水时间、术后恢复半流质饮食时间及术后住院时间均少于Nissen组，术后第1、2、3周胸腹部疼痛、腹胀不适发生率及术后1、2、3、4周吞咽困难发生率均低于Nissen组，差异均有统计学意义(P<0.05),而两组术中出血量、术后拔除引流管时间、术后首次排气时间、术后1月内便秘与腹泻发生率比较均无统计学差异(P>0.05)。术后6月两组患者食管pH值<4的次数、反流次数、反流时间、食管下段括约肌压力、DeMeester评分、GERD-Q评分均较术前明显改善(P<...     

腹腔镜食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝

目的：探讨腹腔镜下行食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝的临床疗效和安全性。 方法：回顾性分析2012年1月—2014年2月在我院进行食管裂孔疝修补联合胃底折叠术的58例胃食管反流病合并食管裂孔疝患者临床资料,其中36例在腹腔镜下行食管裂孔疝修补联合胃底折叠术（观察组）,22例患者行开腹手术（对照组）。观察并比较两组患者手术时间、术中出血量、术后住院时间、术后胃肠道功能恢复时间及术后并发症发生情况,手术前及手术后4个月进行反流性疾病问卷（RDQ）调查结果。 结果：观察组手术时间、术后住院时间、术后胃肠道功能恢复时间均明显短于对照组（均P<0.05）;观察组术中出血量及术后并发症发生情况均明显优于对照组（P<0.05）;两组患者RDQ评分显示术后4个月症状均有不同程度的改善,观察组患者症状改善程度优于对照组患者（均P<0.05）。 结论：腹腔镜下行食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝,疗效显著,安全性好,可积极应用于临床上胃食管反流病合并食管裂孔疝的治疗。     

腹腔镜食管裂孔疝修补术联合胃底折叠术对胃食管反流病合并食管裂孔疝患者抗反流效果及生活质量的影响

目的探讨腹腔镜食管裂孔疝修补术联合胃底折叠术对胃食管反流病（gastroesophageal reflux disease,GERD）合并食管裂孔疝（hiatus hernia,HH）患者抗反流效果及生活质量的影响。 方法选取新疆维吾尔自治区人民医院消化科住院部自2015年3月至2017年8月收治的78例GERD合并HH患者为研究对象,分为2组。观察组行腹腔镜HH修补术联合胃底折叠术（42例）,对照组行传统开腹术（36例）。随访观察2组患者手术情况、不良反应发生情况以及RDQ和GLQI评分。 结果观察组患者术中出血量和手术时间、术后住院时间、胃肠道功能恢复时间均低于对照组,差异有统计学意义（P<0.05）。术后3及6个月随访中,观察组的RDQ评分低于对照组,GLQI评分高于对照组（P<0.05）,差异均有统计学意义（P<0.05）。观察组术后不良反应发生率为7.14%,对照组术后不良反应发生率为16.67%,但2组差异无统计学意义（P>0.05）。 结论对于GERD合并HH患者,采用腹腔镜HH修补术联合胃底折叠术的手术方案,手术情况及抗反流效果更好,患者生活质量更高。     

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。     

腹腔镜疝修补术联合Nissen胃底折叠术治疗食管裂孔疝的前瞻性研究

目的探讨腹腔镜疝修补术联合Nissen胃底折叠术治疗食管裂孔疝的效果。方法选择2016年1月至2017年9月本院收治的157例食管裂孔疝病人作为研究对象,根据随机、前瞻性、对照原则,将157例病人随机分到A组(n=75例)和B组(n=82例),两组病人均予以腹腔镜疝修补术,同时A组加以Nissen胃底折叠术治疗,B组加以Toupet胃底折叠术治疗,对比分析两组病人的手术情况、食管反流情况及食管压力。结果两组患者的手术时间、术中出血量、住院天数、并发症情况及复发情况比较,结果均显示无统计学差异(P0.05)。手术前,A组、B组患者的24 h内反流次数、反流时间、长反流次数、酸反流时间百分比、食管下括约肌压力、食管残余压、食管松弛率及无效吞咽情况比较,差异无统计学意义(均为P0.05);手术后6个月,A组、B组患者的24 h内反流次数、反流时间、长反流次数、酸反流时间百分比、食管下括约肌压力、食管残余压、食管松弛率及无效吞咽情况均明显优于手术前,且A组明显优于B组(均为P0.05)。结论腹腔镜疝修补术联合Nissen胃底折叠术在抗反流效果、抑制术后吞咽困难发生、提高食管下括约肌压力方面的效果均明显优于Toupet胃底折叠术。     

腹腔镜Toupet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Toupet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。 方法选取2012年1月至2018年6月,吉林大学第二医院就诊的80例食管裂孔疝合并胃食管反流病患者为研究对象。依据患者具体状况行不同类型的疝修补术,所有患者均行腹腔镜Toupet胃底折叠术。于术后统计患者手术效果及反流情况,观察手术前后食管压变化。 结果与术前相比,术后6个月患者反流时间显著缩短、反流次数与长反流次数显著减少、酸反流时间百分比显著下降,差异均有统计学意义（P<0.05）。与术前相比,术后6个月患者DeMeester及GERDQ评分均显著下降,差异均有统计学意义（P<0.05）。与术前比较,术后6个月患者LES压力、残余压均显著升高,松弛率显著下降,差异均有统计学意义（P<0.05）。 结论腹腔镜Toupet胃底折叠术治疗食管裂孔疝合并胃食管反流病可有效增加食管压力,抑制患者反流症状,疗效良好,值得推广应用。     

腹腔镜胃底折叠术治疗胃食管反流病

目的探讨腹腔镜胃底折叠术治疗胃食管反流病的临床效果。方法2008年1月-2011年11月对40例胃食管反流病行腹腔镜胃底折叠术。腹腔镜单纯胃底折叠术7例（Toupt式）,腹腔镜食管裂孔疝修补加胃底折叠术33例（Nissen式5例,Toupet式28例）。结果手术均获成功,无中转开腹及死亡病例,无术后严重并发症。手术时间75～215min,平均112min;术中出血量10-350ml,平均52ml;术后住院5—10d,平均7d。40例术后随访1—24个月,平均16个月,34例临床症状完全消失,6例症状明显好转。结论腹腔镜胃底折叠术治疗胃食管反流病疗效满意。     

胃食管反流病的腹腔镜外科治疗

目的:探讨腹腔镜手术治疗胃食管反流病的临床效果.方法:回顾性分析2008年1月—2011年9月对33例胃食管反流病患者行腹腔镜食管裂孔疝修补和胃底折叠术的临床资料.腹腔镜单纯胃底折叠术5例(Toupet式),腹腔镜食管裂孔疝修补加胃底折叠术25例(Nissen式3例,Toupet式22例),腹腔镜单纯食管裂孔疝修补术3例.结果:全组患者手术均获成功,手术时间90～185 min.术后平均住院6d.无中转开腹及死亡病例,无术后严重并发症.术后随访1～24个月,32例临床症状完全消失,1例明显好转.结论:对于胃食管反流性疾病,腹腔镜食管裂孔疝修补和胃底折叠术是一种微创、安全、有效的治疗方法.     

腹腔镜抗反流手术治疗胃部分切除术后胃食管反流的疗效观察

目的:探讨腹腔镜抗反流手术治疗胃部分切除术后反流性食管炎的临床疗效.方法:回顾分析2018年2月至2019年10月收治的5例胃部分切除术后反流性食管炎患者的临床资料,均行腹腔镜下食管裂孔疝修补及Nissen胃底折叠术.结果:5例均成功完成腹腔镜下食管裂孔疝修补及Nissen胃底折叠术,无一例中转开腹或开胸手术.手术时间...     

Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy

Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux and a large (≥8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (≤11 months) the patients are doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement of the repair with PTFE mesh. Received: 5 March 1996/Accepted: 3 June 1996     

Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study

BACKGROUND: Postoperative intrathoracic wrap migration is the most frequent morphological complication after laparoscopic antireflux surgery. Previous authors have studied the use of prosthetic materials for hiatal closure to prevent recurrence of hiatal hernia and/or postoperative intrathoracic wrap herniation. HYPOTHESIS: Patients with prosthetic hiatal closure have a higher rate of short-term dysphagia but a significantly lower rate of postoperative intrathoracic wrap herniation at follow-up. DESIGN: Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatoplasty with those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure. SETTING: University-affiliated community hospital. PATIENTS: One hundred consecutive patients undergoing laparoscopic Nissen fundoplication for gastroesophageal reflux disease and hiatal hernia repair. INTERVENTION: Laparoscopic Nissen fundoplication with simple sutured crural closure (n = 50 [group 1]) vs laparoscopic Nissen fundoplication with simple sutured cruroplasty and onlay of a polypropylene mesh (n = 50 [group 2]). MAIN OUTCOME MEASURES: Recurrences; complications; results of esophageal manometry, 24-hour pH monitoring, esophagogastroduodenoscopy, and barium swallow test; and symptomatic outcome. RESULTS: Patients in both groups had similar preoperative values in esophageal manometry, 24-hour pH monitoring, and symptom scoring. At the 3-month and 1-year follow-ups, functional outcome variables (lower esophageal sphincter pressure and DeMeester score) improved significantly compared with the preoperative values. A higher postoperative dysphagia rate could be evaluated in group 2. An intrathoracic wrap migration occurred in 13 patients (26%) in group 1 vs 4 (8%) in group 2 (P<.001). CONCLUSION: Laparoscopic Nissen fundoplication with prosthetic cruroplasty is an effective procedure to reduce the incidence of postoperative hiatal hernia recurrence and intrathoracic wrap herniation.     

Surgical management of hiatal hernia in children.

Hiatal hernia should be included in the differential diagnosis of all children with emesis and failure to thrive, since early diagnosis is imperative to prevent the irreversible esophageal damage from long-standing peptic esophagitis. The Nissen fundoplication as described in this paper appears to be far superior to gastropexy in preventing recurrence of gastroesophageal reflux. Colon interposition should be reserved for those cases in which hiatal herniorrhaphy is technically impossible. Successful repair of the hiatal hernia results in rapid improvement in the nutritional status of these children.     

婴幼儿食管裂孔疝食管下括约肌功能研究

目的 了解食管裂孔疝（ＨＨ）患儿胃食管动力与胃食管反流（ＧＥＲ）的关系以及评估手术疗效。方法 １９９４￣１９９６年对２６例经钡餐造影（ＧＩ）诊断的ＨＨ病儿（Ⅰ组：滑疝１６例,Ⅱ组：旁疝、混合疝共１０例）,进行了手术前、反食管测压和２４小时食管ｐＨ监测。结果 所有病儿均存在不同程度的ＧＥＲ,最后反流时间、总ｐＨ〈４的时间百分率以卧位更明显,术后各反流参数明显下降。两组术一均有食管下段托约肌长度（Ｌ     

Sliding hiatal hernia in patients with gastroesophageal reflux: physiopathology and surgical treatment

BACKGROUND: The aims of the study were to evaluate how the sliding hiatal hernia, in patients with gastroesophageal reflux disease (GERD), acts on the lower esophageal sphincter (LES) and esophageal clearance, and how surgical therapy corrects the physiopathological parameters. METHODS: Records of 25 patients with only GERD and of 15 with GERD associated to hiatal hernia (> 3.5 cm) were reviewed. Ten subjects without symptoms and/or endoscopic and functional signs of GERD were considered as control group. The selection of the patients was done by reviewing radiographic examination, endoscopy and functional tests (esophageal manometry, pH-monitoring). RESULTS: Manometry showed a greater LES incompetence (pressure and length) and a worse peristalsis (distal amplitude) in the group with reflux and hiatal hernia against patients with reflux only. Also, patients with hiatal hernia had more acid exposure (total time pH < 4 in the distal esophagus) and a longer time of esophageal clearance, at pH-monitoring. The functional tests in 8 patients, before and after laparoscopic Toupet fundoplication with posterior closing of the crura, showed a normalised LES, esophageal clearance and acid exposure. Esophageal peristalsis did not show any statistically significance. CONCLUSIONS: The presence of hiatal hernia, in patients with GERD, causes worse LES, peristalsis and clearance with a greater acid exposure of the esophagus. Fundoplication, by reconstructing the sphincter-diaphragm unit, normalises the preoperative physiopathology situation but without an effective peristalsis improvement.     

Influence of hiatal hernia on lower esophageal sphincter function.

Sliding hiatal hernia has long term been implicated as a cause of lower esophageal sphincter (LES) incompetence and gastroesophageal reflux. The physics of LES function in hiatal hernia were investigated in in vitro and in vivo experiments. In vitro models of sliding hernias were constructed from excised canine gastroesophageal specimens. A "sphincter" was simulated with a rubber band around the gastroesophageal junction. It was found that placement of a ligature "hernia ring" on the stomach increased the opening pressure of the model sphincter. Addition of a tissue "hernia sac" sutured to the esophagus above the sphincter further increased the opening pressure, the protective effect being related to the pressure transmitted from the stomach to the hernia sac. There was no fluid leakage from the hernia sac between the hernia ring and the stomach. In anesthetized dogs (in vivo model) gastric and esophageal pressures were measured during gastric infusion while the LES gas way to reflux. A ligature tied loosely around the stomach to simulate a "hernia ring" and a sliding hernia without a hernia sac increased both the opening and the closing pressures of the LES by 36 +/- 18% and 35 +/- 20% (mean +/- SD), respectively. The opening pressure was increased by a decrease in gastric wall tension at the gastroesophageal junction, which was caused by the decreased radius of the herniated portion of the stomach. Pressure transmitted from the stomach to the hernia sac added to the LES pressure, and thereby further increased the opening pressure of the sphincter. The results explain how gastroesophageal reflux may be prevented in patients with hiatal hernia. It was recognized that the hernia sac may protect the sphincter, provided that it inserts into the esophagus above the LES.