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1.
腹腔镜食管裂孔疝修补胃底折叠术 总被引:6,自引:0,他引:6
田文 《中国实用外科杂志》2006,26(11):820-822
食管裂孔疝多见于40岁以上的病人。其症状主要表现为胸痛、吞咽困难和咽下疼痛,并常伴有反流性食管炎引起的胸骨后及背部烧灼感。食管裂孔疝常伴有食管韧带松弛和食管下段括约肌功能减弱,易发生胃液反流,导致胃食管反流病(GERD)。胃食管反流病的发生机制与食管裂孔疝、食管下端括约肌缺陷等有关,常须长期服用质子泵抑制剂和胃肠动力药物治疗。 相似文献
2.
Laparoscopic repair of large paraesophageal hiatal hernia 总被引:8,自引:0,他引:8
Dahlberg PS Deschamps C Miller DL Allen MS Nichols FC Pairolero PC 《The Annals of thoracic surgery》2001,72(4):1125-1129
BACKGROUND: The objective of this study was to analyze our initial results after laparoscopic repair of large paraesophageal hiatal hernias. METHODS: Between October 1997 and May 2000, 37 patients (23 women, 14 men) underwent laparoscopic repair of a large type II (pure paraesophageal) or type III (combined sliding and paraesophageal) hiatal hernia with more than 50% of the stomach herniated into the chest. Median age was 72 years (range 52 to 92 years). Data related to patient demographics, esophageal function, operative techniques, postoperative symptomatology, and complications were analyzed. RESULTS: Laparoscopic hernia repair and Nissen fundoplication was possible in 35 of 37 patients (95.0%). Median hospitalization was 4 days (range 2 to 20 days). Intraoperative complications occurred in 6 patients (16.2%) and included pneumothorax in 3 patients, splenic injury in 2, and crural tear in 1. Early postoperative complications occurred in 5 patients (13.5%) and included esophageal leak in 2, severe bloating in 2, and a small bowel obstruction in 1. Two patients died within 30 days (5.4%), 1 from delayed splenic bleeding and 1 from adult respiratory distress syndrome secondary to a recurrent strangulated hiatal hernia. Follow-up was complete in 31 patients (94.0%) and ranged from 3 to 34 months (median 15 months). Twenty-seven patients (87.1%) were improved. Four patients (12.9%) required early postoperative dilatation. Recurrent paraesophageal hiatal hernia occurred in 4 patients (12.9%). Functional results were classified as excellent in 17 patients (54.9%), good in 9 (29.0%), fair in 1 (3.2%), and poor in 4 (12.9%). CONCLUSIONS: Laparoscopic repair of large paraesophageal hiatal hernias is a challenging operation associated with significant morbidity and mortality. More experience, longer follow-up, and further refinement of the operative technique is indicated before it can be recommended as the standard approach. 相似文献
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Background: Several studies have shown that large hiatal hernias are associated with a high recurrence rate. Despite the problem of recurrence,
the technique of hiatal herniorrhaphy has not changed appreciably since its inception. In this 3-year study we have evaluated
laparoscopic hiatal hernia repair in individuals with a hernia defect greater than 8 cm in diameter.
Methods: A series of 35 patients with sliding or paraesophageal hiatal hernias was prospectively randomized to hiatal hernia repair
with (n= 17) or without (n= 18) polytetrafluoroethylene (PTFE). All patients had an endoscopic and radiographic diagnosis of large hiatal hernia. Both
repairs were performed by using interrupted stitches to approximate the crurae. In the group randomized to repair with prosthesis,
PTFE mesh with a 3-cm ``keyhole' was positioned around the gastroesophageal junction with the esophagus through the keyhole.
The PTFE was stapled to the diaphragm and crura with a hernia stapler.
Results: Patients were followed with EGD and esophagogram at 3 months postoperatively, and with esophagogram every 6 months thereafter.
Individuals with PTFE had a longer operation time, but the 2-day hospital stay was the same in both groups. The cost of the
repair was $1050 ± $135 more in the group with the prosthesis. There were two complications (1 pneumonia, 1 urinary retention)
in the group repaired with PTFE and one complication (pneumothorax) in the group without prosthesis. The group without PTFE
was notable for three (16.7%) recurrences within the first 6 months of surgery.
Conclusion: On the basis of these preliminary results it appears that repair with PTFE may confer an advantage, with lower rates of recurrence
in patients with large hiatal hernia defects.
Received: 1 May 1998/Accepted: 22 December 1998 相似文献
5.
Background The recurrence rate after laparoscopic repair of hiatal hernias with paraesophageal involvement (LRHP) is reported to be high.
Mesh reinforcement has been proposed with the objective of solving this problem. This study aimed to compare the outcome of
LRHP before and after the introduction of mesh reinforcement.
Methods Between 1992 and 2003, 56 consecutive patients received LRHP including posterior crurorrhaphy and additional fundoplication.
Of these 56 patients, 17 underwent a mesh-reinforced hiatoplasty. Perioperative outcome was assessed retrospectively, and
follow-up assessment was performed according to protocol including a barium contrast swallow.
Results The follow-up period averaged 52 ± 31 months (range, 9–117 months). The recurrence rate for hiatal hernia without mesh reinforcement
was 19% (7/36). No recurrence (0/16) was observed in patients with mesh reinforcement. The intraoperative complication rate
was 9%, and the perioperative morbidity rate was 14%. There were neither mesh-related complications nor operation-related
deaths.
Conclusions Although challenging, LRPH is a successful procedure. The high recurrence rate reported in the literature can be reduced by
additional mesh reinforcement. 相似文献
6.
目的探讨腹腔镜补片修补巨大食管裂孔疝的安全性和有效性。方法 2006年5月至2010年5月应用腹腔镜补片修补食管裂孔疝12例,采用全身麻醉,材料为聚丙烯和聚四氟乙烯补片,剪裁7.5cm×7.5cm大小圆形补片,用EMS固定于膈肌上。结果全部患者手术成功。术后1个月复查,症状按Visick评分:12例均为VisickⅠ。胃镜检查:食管下端糜烂减轻或消失。食管压力测定:(16.33±3.07)mmHg。24h食管内pH值〈4,总时间百分比均〈4%。钡餐检查:12例胸腔胃全部位于膈下腹腔内。12例患者随访1~5年,无胃烧灼感、反流症状,胃镜食管炎消失,钡餐食管裂孔疝无复发。5例贫血者,血色素升至正常。结论腹腔镜下补片修补食管裂孔疝安全、有效且复发率低。补片相关并发症需进一步随访观察。 相似文献
7.
田文 《中华腔镜外科杂志(电子版)》2010,3(2):4-6
<正>食管裂孔疝(hiatus hernia)是指食管腹段、食管胃连接部和部分胃组织通过膈食管裂孔凸入胸腔形成的一种疝。食管裂孔疝属膈疝中最常见的一种,占90%以上,多见于40岁以上的患者,其症状主要表现为胸 相似文献
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Mesh crural repair of large paraesophageal hiatal hernias. 总被引:6,自引:0,他引:6
Surgical repair is indicated in patients with paraesophageal hernias but is associated with a high recurrence rate. Our objective was to assess the safety and efficacy of mesh reinforcement of the crural closure in laparoscopic paraesophageal hernia repair. We conducted a 7-year retrospective review of all patients undergoing laparoscopic paraesophageal hernia repair with or without use of mesh. The main outcome measures were use of mesh, reason for use, age, sex, preoperative symptoms, length of operation, length of hospital stay, postoperative complications, and long-term follow-up conducted by physician interview. Twelve patients were repaired with mesh (Group A) and 12 without (Group B). Age, sex, operating time, length of hospital stay, and postoperative complications were similar in both groups. In Group A two patients required an interposition graft and ten required mesh reinforcement of the crural closure. One Group A patient developed an early recurrence requiring a reoperation, and one Group B patient developed a gastric leak where the fundus was sutured to the crura. The remainder of the patients experienced resolution of their symptoms at 2 weeks follow-up. Long-term follow-up (average 37 months) showed one Group B patient with a recurrence of reflux symptoms, but an upper gastrointestinal study showed no recurrence of hernia. All others remained asymptomatic. We conclude that the use of mesh in laparoscopic repair of large paraesophageal hernias appears safe and may reduce recurrence. 相似文献
10.
Introduction
This study aims to examine the impact of laparoscopic repair of large hiatal hernia on dyspnoea severity, respiratory function and quality of life. 相似文献11.
12.
Laparoscopic repair of esophageal hiatal hernia 总被引:2,自引:0,他引:2
Hiatal hernias are usually classified into three distinct types: type I, sliding hernia; type II, paraesophageal hernia; and type III, a combination of type I and II hernias. Presentation of type I hernia is so-called reflux symptoms, in contrast with the symptoms associated with mechanical obstruction of the herniated stomach in type II and III hernias. Surgical indications for type I hernia depend upon the severity of esophagitis. In type II and III hernias, severe symptoms and complications represent the chief indications for repair. Totally intrathoracic stomach hernias generally present such a risk of volvulus, strangulation, and perforation that surgery is indicated even in asymptomatic and uncomplicated cases. Although the pathophysiology is different, the Nissen procedure is the surgical procedure of choice for both types of hiatal hernia. Since the first report in 1993, the laparoscopic Nissen procedure has gained wide acceptance. We have so far experienced 26 cases of hiatal hernia, 18 of type I and 8 of type II and III hernias. We used the laparoscopic Nissen procedure in all cases. There were no conversions to the open procedure. Hiatal hernia recurred only in one case with a short esophagus preoperatively. The laparoscopic Nissen procedure is here to stay for the repair of hiatal hernias regardless of their type. 相似文献
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目的 探讨腹腔镜下应用补片行食管裂孔疝无张力修补术的临床效果. 方法 2006年8月至2009年10月我们对46例食管裂孔疝患者在腹腔镜下进行食管裂孔疝应用补片无张力修补,并同期给予部分胃底折叠术.结果 45例患者成功地在腹腔镜下进行了无张力修补,1例患者因术中出现食道损伤,中转开胸治疗.手术时间70~210min,平均90min. 术中出血10~110ml,平均25ml,均无输血.所有患者术后症状完全缓解.术后住院3~30d,平均住院日为5d.对45例患者术后进行3~25个月随访,平均12个月,未发现食管裂孔疝复发病例及有关补片并发症的发生.结论 腹腔镜下食管裂孔疝无张力修补术是一种安全有效的微创方法,具有创伤少、恢复快、术后复发率低等特点. 相似文献
15.
目的 探讨腹腔镜下巨大食管裂孔疝应用补片修补和部分胃底折叠术的安全性及有效性。 方法 2006年8月至2009年4月中国人民解放军总医院普通外科对13例巨大食管裂孔疝病人行腹腔镜下裂孔疝补片修补,并同期行部分胃底折叠术。 结果 12例手术成功,1例伴有短食管,手术过程中因分离食管时出现食管损伤中转开胸治疗。手术时间90~180min,平均110min。 术中出血30~120mL,平均50mL,均未输血。12例术后症状完全缓解。术后住院时间3~30d,平均6d。术后随访3~25个月,平均12个月,未发现复发病例。 结论 对于巨大食管裂孔疝,腹腔镜下补片修补是一种安全有效的方法,具有创伤少,恢复快、副反应小的特点。 相似文献
16.
目的探讨使用腹腔镜行食管裂孔疝修补术的安全性和疗效评价。方法对38例食管裂孔疝患者使用腹腔镜行食管裂孔疝修补术,做胃底360°折叠术(Nissen术),9例应用补片修补疝缺口,29例采用7号丝线缝合。结果38例腹腔镜食管裂孔疝修补术全部获得成功。手术时间30~190min,平均手术时间110min,失血10~50ml;术后24~48h进流质饮食,无术后并发症;术后平均住院5.7d。结论腹腔镜下胃底Nissen折叠术式具有疗效好、安全和创伤小的优点。值得进一步推广应用。 相似文献
17.
Background Although laparoscopic repair of large, mostly paraesophageal hiatal hernias is widely applied, there is a great concern regarding
the higher recurrence rate associated with this procedure. In order to reduce this high recurrence rate, several techniques
have been developed, mostly applying a mesh prosthesis for hiatal reinforcement.
Methods We have recently introduced a new laparoscopic technique in which the hiatal closure is reinforced with the teres ligament.
To date 26 patients have been entered into this ongoing prospective study. After the operation patients were called back on
a regular basis for symptom evaluation and barium swallow. All 26 patients agreed to undergo barium swallow, with a mean follow-up
of 35 months.
Results The mean operative time was 115 min. Perioperative morbidity was 11.5%, and conversion to an open procedure was performed
in six cases. No mortality was registered. Anatomic recurrence, investigated by barium swallows was observed in four patients
(15.3%). Of those four, only one (3.85%) had a symptomatic recurrent paraesophageal hernia; the other three had asymptomtic
sliding hernias. In three of the four patients with anatomic recurrence, the diameter of the hiatal hernia was greater than
9 cm at the original operation, and the fourth patient underwent reoperation for recurrent hiatal hernia. No symptomatic recurrence
was found in patients with diameter of hiatal hernia between 6 and 9 cm.
Conclusions Laparoscopic reinforcement of the hiatal closure with the ligamentum teres is safe and effective treatment for large hiatal
hernias. However, it appears that patients with extremely large hiatal hernias are at greater risk of recurrence, and therefore
large hernias are not suitable for this new technique. 相似文献
18.
Laparoscopic repair of large hiatal hernias 总被引:7,自引:0,他引:7
Aly A Munt J Jamieson GG Ludemann R Devitt PG Watson DI 《The British journal of surgery》2005,92(5):648-653
BACKGROUND: The repair of large hiatal hernias can be technically challenging. Most series describing laparoscopic repair report only symptomatic outcomes and the true recurrence rate, including asymptomatic recurrence, is not well documented. This study evaluated the long-term outcome of laparoscopic repair of large hiatal hernias. METHODS: All patients who had undergone laparoscopic repair of a large hiatus hernia (more than 50 per cent of the stomach in the hernia) with a minimum 2-year clinical follow-up were identified from a prospectively maintained database. A standardized questionnaire was used to assess symptoms and a barium swallow radiograph was performed to determine anatomy. Multivariate analysis was used to identify factors associated with recurrence. RESULTS: Of 100 eligible patients, clinical follow-up was available in 96. Follow-up ranged from 2 to 8 (median 4) years. In patients with preoperative reflux symptoms, there were significant improvements in heartburn and dysphagia scores after surgery. Overall, 80 per cent of patients rated their outcome as good or excellent. Sixty patients underwent a postoperative barium meal examination that identified 14 radiological hernia recurrences (eight small, three medium and three large). Four other patients in this group of 60 had previously undergone reoperation for early and late recurrence (two of each), giving an overall recurrence rate of 18 of 60 (30 per cent). One third of patients with recurrence were totally asymptomatic and the presence of postoperative symptoms did not reliably predict the presence of anatomical recurrence. Younger age and increased weight at operation were independent risk factors contributing to recurrence. CONCLUSIONS: Laparoscopic repair of large hiatal hernias yields good clinical outcome. Recurrence after laparoscopic repair seems to be more common than previously thought. Objective anatomical studies are required to determine the true recurrence rate. The majority of recurrences are not large and do not cause significant symptoms. 相似文献
19.
Laparoscopic antireflux surgery and repair of hiatal hernia 总被引:2,自引:0,他引:2
Prof. A. Cuschieri M.D. 《World journal of surgery》1993,17(1):40-45
Laparoscopic mobilization of the esophagus and esophagogastric (O-G) junction enables the safe and effective performance of endoscopic antireflux surgery for intractable reflux esophagitis. The two antireflux procedures that we have evaluated in clinical practice at this institution are the ligamentum teres cardiopexy (n=9) and partial posterior fundoplication (n=5). More recently, laparoscopic repair of large symptomatic hiatal hernia (sliding, paraesophageal, and mixed) has also been introduced (n=4). The procedure entails reduction of the hernia, mobilization of the O-G junction with crural repair by a continuous suture technique employing a special preformed jamming loop knot, followed by total fundoplication, which is fixed proximal to the anterior margin of the diaphragmatic hiatus and distal to the O-G junction. The early results (maximum follow-up 18 months) of this experience have been favorable, with minimal morbidity, early hospital discharge, and effective control of reflux symptoms without adverse sequelae. Laparoscopic antireflux surgery is an alternative to long-term medication in patients with intractable esophagitis, and laparoscopic repair of large hiatal hernias offers significant advantage over the conventional open surgical approach in terms of rapid convalescence.
Resumen La movilización laparoscópica del esófago y de la union esofagogástrica (EG) hace posible la realización segura y eficaz de cirugía antirreflujo endoscópica para el manejo de la esofagitis de reflujo intratable. Los dos procedimientos antirreflujo que han sido valorados en la práctica clínica en esta institución son la cardiopexia con el ligamento redondo (n=9) y la fundoplicación parcial posterior (n=5). Más recientemente también se ha introducido la reparación laparoscópica de la hernia hiatal grande y sintomática (por deslizamiento, paraesofágica y mixta) (n=4). El procedimiento implica la reducción de la hernia, la movilización del la union EG con reparación de las cruras mediante técnica de sutura continua empleando un nudo de seguridad especial preatado, seguida de fundoplicación total que es fijada en la región proximal al margen anterior del hiato diafragmático y distalmente a la unión EG. Los primeros resultados (seguimiento máximo de 18 meses) de esta experiencia han demonstrado ser favorables, con minima morbilidad, egreso hospitalario temprano y control efectivo de los síntomas de reflujo sin secuelas adversas. La cirugia laparoscópica antirreflujo es una alternativa terapéutica frente al tratamiento médico a largo plazo en pacientes con esofagitis intratable, y la reparación laparoscópica de grandes hernias hiatales ofrece ventajas significativas, en términos de convalescencia rápida, sobre el abordaje abierto.
Résumé La mobilisation, sous coelioscopie, de l'oesophage et de la jonction oesogastrique (JOG) permet d'envisager la chirurgie antireflux par voie coelioscopique pour oesophagite rebelle au traitement médical. Les deux procédés antireflux qui ont été évalués cliniquement dans notre unité sont la cardiopexie par le ligament rond (n=9) et la fundoplicature postérieure partielle (n=5). Plus récemment, on a réalisé par coelioscopie la cure de la hernie hiatale symptomatique (par glissement, paraoesophagienne, et mixte) (n=4). L'intervention comporte la réduction de la hernie, la mobilisation de la JOG, un rapprochement des piliers par un surjet en utilisant une technique spéciale de noeud préformé autobloquant suive d'une fundoplicature complète, fixée en haut à l'hiatus et en bas à la JOG. Les résultats précoces (suivi maximum de 18 mois) ont été favorables avec une morbidité minimale, une sortie précoce, et un bon contrÔle du reflux sans complication. La cure du reflux est une alternative au traitement médical au long cours et offre d'importants avantages sur la technique traditionnelle en termes de récupération rapide.相似文献
20.
Nicole E. SharpHanna Alemayehu MD Amita DesaiGeorge W. Holcomb III MD MBA Shawn D. St. Peter 《The Journal of surgical research》2014