腹腔镜胃间质瘤切除联合食道裂孔疝修补术的临床体会

目的探讨腹腔镜下胃间质瘤切除联合食道裂孔疝修补术的临床体会。方法回顾性分析8例腹腔镜胃间质瘤切除联合食道裂孔疝修补术的临床资料。结果 8例均获成功,无并发症发生及中转开腹,术后7～9d痊愈出院。结论腹腔镜下胃间质瘤切除联合食道裂孔疝修补术能安全有效的处理胃食道多发病变,在掌握好手术适应症的条件下是安全可行的。     

针式腹腔镜用于儿童腹部手术36例报告

目的 :探讨针式腹腔镜用于治疗儿童腹部疾病的价值。方法 :回顾分析腹腔镜下行巨结肠根治术 ,美克尔憩室切除术 ,胆囊切除术 ,卵巢囊肿切除术 ,幽门肥厚切开术 ,食道裂孔疝修补术等患者的临床资料。结果 :2例中转开腹 ,余 34例顺利完成手术 ,术后患者康复。结论 :儿童腹部手术应用针式腹腔镜优点明显 ,腹腔镜在诊断腹部疑难疾病中有重要价值。随技术进步和设备改善腹腔镜手术适应证将逐步拓宽     

腹腔镜在食管裂孔疝修补术中的临床应用

目的探讨腹腔镜在食道裂孔疝修补术中应用的疗效及安全性。方法运用腹腔镜对21例食道裂孔疝患者行食道裂孔疝修补术,其中13例食道裂孔缺损≥4 cm者使用巴德Cru-raSoft补片进行修补,8例缺损4 cm者用2-0普理灵缝线连续缝合将两膈肌脚关闭。同时将胃底固定于食道左侧膈肌下,以恢复锐性His角。结果 21例均顺利完成疝修补术,无中转开腹,未出现并发症。平均手术时间117 min;平均出血量约36.7 ml;平均住院日3.7 d。术后3个月行胃镜复查,显示患者的食道炎均已明显好转,未见消化性溃疡或糜烂性胃炎;术后随访3～30个月,单纯缝合修补者有2例复发。结论对于老年人要适当控制气腹的压力。腹腔镜手术的高清晰度、宽广视野是直视手术所无法比拟的,用以治疗食道裂孔疝有手术损伤小、出血少、患者恢复快、住院时间短等优点,其并发症的发生率和死亡率都比开腹直视手术要低。腹腔镜下行食道裂孔疝修补的治疗是安全可行的,值得临床推广应用。     

腹腔镜食管裂孔疝修补术并发症的预防

目的探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性。减少手术并发症,随访腹腔镜治疗食道裂孔疝的效果。方法对280例食管裂孔疝患者使用腹腔镜行食管裂孔疝修补术,其中132例做胃底270°部分折叠术（Toupet术）,148例做胃底360°折叠术（Nissen术）。36例应用补片修补疝缺口,剩余患者采用直接缝合。结果 280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。结论腹腔镜食道裂孔疝修补术具有疗效确定、安全和创伤小的优点。并发症率极低。     

��ǻ��ʳ���ѿ����޲���

目的　探讨腹腔镜食道裂孔疝修补术的可行性及安全性。方法　回顾性分析 2 0 0 1年 3月至 2 0 0 3年12月天津南开医院行腹腔镜食道裂孔疝修补术 11例病人的临床资料。结果　 10例行裂孔疝修补后同时行胃底折叠术 ,其中 7例行Nissen胃底折叠术 ,3例行Toupet胃底折叠术 ,1例仅行裂孔修补术。术后症状完全缓解。食道下段压力由 (8 6± 2 4 )mmHg(1mmHg =0 133kPa)提高到 (18 2 0± 3 4 3)mmHg(P <0 0 1) ,2 4hpH值监测评分由 5 3 4± 39 7降低到 8 0 4± 2 12 (P <0 0 1) ,较手术前有明显改善 ,并达到正常范围。无手术并发症 ,无中转开腹及死亡病例。结论　对于食道裂孔疝 ,腹腔镜食道裂孔疝修补术是一种安全、有效的治疗方法     

腹腔镜食道裂孔疝修补术的临床效果分析：附51例报告

目的:探讨腹腔镜食道裂孔疝修补术的安全性和疗效。方法:回顾分析2012年7月—2016年7月51例行腹腔镜食道裂孔疝修补术的患者临床资料。结果:51例患者均顺利接受腹腔镜食道裂孔疝修补术。术中裂孔缝合修补后均采用补片加强固定。对无明显禁忌证患者,同时行Dor胃底折叠术。平均时间(100±15.4)min,术中出血量平均(28±15.4)mL,术后平均住院时间2d。术后胸痛、进食后哽噎等疝囊压迫症状明显缓解,反酸,烧心等反流症状也得到明显改善。无严重并发症发生,均在4周内恢复正常饮食。平均随访32个月,未见裂孔疝复发及补片相关并发症。结论:腹腔镜食道裂孔疝修补术是安全有效的手术方式,食道裂孔缝合关闭后使用补片加强修补可以降低裂孔疝的复发率。     

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...     

腹腔镜食管裂孔疝修补术联合抗反流手术临床疗效研究（附835例报告）

目的 探讨腹腔镜食管裂孔疝修补术联合抗反流手术治疗胃食管反流病（GERD）合并食管裂孔疝的安全性和疗效。方法 回顾性分析2005年9月至2015年5月新疆维吾尔自治区人民医院收治的835例GERD合并食管裂孔疝病人的临床资料,均行腹腔镜食管裂孔疝修补术+胃底折叠术。结果 835例均成功完成腹腔镜食管裂孔疝修补术+胃底折叠术,无一例中转开放手术。其中联合其他手术183例（21.9%）。手术时间55.3（40～90）min;术中出血量20.4（5～50）mL,无术中术后输血者。术后24～48 h全流质饮食。术后随访3个月至10年,平均37.5个月。56例（6.7%）病人术后出现并发症,其中吞咽困难28例,食管裂孔疝复发（折叠的胃底疝入胸腔）4例,症状复发18例,胃肠胀气综合征6例。结论 腹腔镜食管裂孔疝修补术+胃底折叠术安全有效、创伤小、恢复快、并发症少,并可联合手术治疗其他疾病,是GERD合并食管裂孔疝病人的理想选择。     

腹腔镜胆囊切除术联合腹腔内补片植入腹股沟疝修补术24例报告

目的 探讨腹腔镜联合手术的优越性.方法 回顾分析2004年10月至2009年12月开展腹腔镜胆囊切除术联合腔镜下腹腔内补片植入腹股沟疝修补术24例临床资料.结果 本组24例手术均获成功,无中转开腹,平均手术时间为(41.081±10.887)min;术后住院时间平均为(3.630±0.921)d;随访0.5～6年,无一例复发及补片感染.结论 腹腔镜联合手术一次处理两种或两种以上腹部疾病是安全有效的,具有创伤小、痛苦轻、恢复快等优点.     

腹腔镜下食管裂孔疝修补术

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.     

腹腔镜治疗成人食管裂孔疝手术适应证的选择(附20例报告)

目的探讨腹腔镜修补术治疗食管裂孔疝的适应证,总结相关临床治疗经验。方法回顾性分析武汉市中心医院疝与腹壁外科自2013年1月至2015年6月期间收治的20例食管裂孔疝病人的临床资料。结果 20例病人均行腹腔镜疝修补治疗,临床症状好转出院,其中14例行补片修补,6例行单纯缝合修补。手术时间为40~120 min,平均手术时间为75 min;失血量为10~50 ml,平均为25 ml;住院时间为3~8 d,平均为4.5 d;术后无严重并发症。术后1个月复查上消化道钡餐检查均显示疝囊复位良好。术后随访1年半,未见症状复现及疝复发。结论合理选择手术适应证是腹腔镜治疗食管裂孔疝的关键。     

Simultaneous laparoscopic paraesophageal hernia repair and sleeve gastrectomy in the morbidly obese

BackgroundMorbid obesity is associated with increased rates of hiatal and paraesophageal hernias. Although laparoscopic sleeve gastrectomy is gaining popularity as the procedure of choice for morbid obesity, there is little data regarding the management of paraesophageal hernias found intraoperatively. The aim of this study was to evaluate the feasibility and benefits of a combined sleeve gastrectomy and paraesophageal hernia repair in morbidly obese patients.MethodsFrom May 2011 to February 2013, 23 patients underwent laparoscopic sleeve gastrectomy combined with the repair of a paraesophageal hernia. Only 4 patients had a large hiatal hernia documented preoperatively on esophagogastroduodenoscopy (EGD). The body mass index (BMI), operative time, length of stay, and complications were evaluated.ResultsThe average operative time was 165 minutes (115–240 minutes) and length of stay was 2.83 days (2–6 days). All patients were female except for one, with an average age of 53.4 years and a BMI of 41.9 kg/m². There were no complications during the procedures. Mean follow-up was 6.16 months (1–19 months), and mean excess weight loss was 39%. The average cost of admission for a combined procedure ($10,056), was slightly higher than a laparoscopic sleeve gastrectomy ($8905) or laparoscopic paraesophageal hernia repair ($8954) done separately.ConclusionsLaparoscopic sleeve gastrectomy combined with a paraesophageal hernia repair is well-tolerated and feasible in morbidly obese patients. Surgeons should be aware that preoperative EGD is not effective at diagnosing large hiatal or paraesophageal hernias. Surgeons with the skill set to repair paraesophageal hernias should do a combined procedure because it is well-tolerated, feasible, and can reduce the cost of multiple hospital admissions.     

Utilization and outcomes of laparoscopic versus open paraesophageal hernia repair

The optimal operative approach for repair of diaphragmatic hernia remains debated. The aim of this study was to examine the utilization of laparoscopy and compare the outcomes of laparoscopic versus open paraesophageal hernia repair performed at academic centers. Data was obtained from the University HealthSystem Consortium database on 2726 patients who underwent a laparoscopic (n = 2069) or open (n = 657) paraesophageal hernia repair between 2007 and 2010. The data were reviewed for demographics, length of stay, 30-day readmission, morbidity, in-hospital mortality, and costs. For elective procedures, utilization of laparoscopic repair was 81 per cent and was associated with a shorter hospital stay (3.7 vs 8.3 days, P < 0.01), less requirement for intensive care unit care (13% vs 35%, P < 0.01), and lower overall complications (2.7% vs 8.4%, P < 0.01), 30-day readmissions (1.4% vs 3.4%, P < 0.01) and costs ($15,227 vs $24,263, P < 0.01). The in-hospital mortality was 0.4 per cent for laparoscopic repair versus 0.0 per cent for open repair. In patients presenting with obstruction or gangrene, utilization of laparoscopic repair was 57 per cent and was similarly associated with improved outcomes compared with open repair. Within the context of academic centers, the current practice of paraesophageal hernia repair is mostly laparoscopy. Compared with open repair, laparoscopic repair was associated with superior perioperative outcomes even in cases presenting with obstruction or gangrene.     

腹腔镜联合手术

腹腔镜联合手术是其切口创伤小、灵活机动、便于多病联治优越性的突出体现。作者自１９９１年以来实施的１０００余例腹腔镜外科手术中有５２例为联合手术。其中胆囊与阑尾联合切除２４例；胆囊切除加非寄生虫性肝囊肿开窗引流２例；胆囊切除联合腹股沟斜疝内环夹闭３例；联合脐疝修补１例；胆囊切除加胆总管切开取石、Ｔ管引流１２例；胆囊与右侧卵巢囊肿、左侧附件联合切除１例；胆囊与子宫肌瘤联合切除１例；胆囊与右肾错构瘤联合切除１例；右腹股沟斜疝修补加左精索曲张静脉高位扎闭２例；食管裂孔疝修补加胃底折叠术３例。５２例腹腔镜联合手术中除２例中转开腹外，其余的５０例均获得成功。作者认为：只要严格掌握联合手术指征，腹腔镜联合手术能够安全、有效地联合处理两种或两种以上的腹部病变，使此类患者充分享受微创外科手术的优越性，并相对地节省医疗费用，具有一定的社会经济效益。     

腹腔镜治疗食管裂孔疝的临床应用

目的探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性。方法对26例食管裂孔疝患者使用腹腔镜行食管裂孔疝修补术，其中16例做胃底270。部分折叠术（Toupet术），10例做胃底360°胃底折叠术（Nissen术）。19例应用补片修补疵缺口，7例采用7号丝线缝合。结果26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26例患者的反酸症状均在24h内缓解，术后停用抗酸药物，修补术具有疗效确定、安全和创伤小的优点。值得进一步推广应用。     

食管裂孔疝的腹腔镜治疗

目的:探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全牲.方法:对62例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,其中46例做胃底270o部分折叠术(Toupet术),16例做胃底360o折叠术(Nissen术).21例应用补片修补疝缺口,41例采用7号丝线缝合.随访时间中位数18个月.结果:62例腹腔镜食管裂孔疝修补术全部成功.手术时间110(30～190)min,失血10～50 mL;术后24～48 h进流质饮食,无术后并发症;术后平均住院5.7 d.结论:腹腔镜食管裂孔疝修补术具有疗效确定、安全和创伤小的优点,值得进一步推广应用.     

Durability of laparoscopic repair of paraesophageal hernia.

OBJECTIVES: To define a method of primary repair that would minimize hernia recurrence and to report medium-term follow-up of patients who underwent laparoscopic repair of paraesophageal hernia to verify durability of the repair and to assess the effect of inclusion of an antireflux procedure. SUMMARY BACKGROUND DATA: Primary paraesophageal hernia repair was completed laparoscopically in 55 patients. There were five recurrences within 6 months when the sac was not excised (20%). After institution of a technique of total sac excision in 30 subsequent repairs, no early recurrences were observed. METHODS: Inclusion of an antireflux procedure, incidence of subsequent hernia recurrence, dysphagia, and gastroesophageal reflux symptoms were recorded in clinical follow-up of patients who underwent a laparoscopic procedure. RESULTS: Mean length of follow-up was 29 months. Forty-nine patients were available for follow-up, and one patient had died of lung cancer. Mean age at surgery was 68 years. The surgical morbidity rate in elderly patients was no greater than in younger patients. Eleven patients (22%) had symptoms of mild to moderate reflux, and 15 were taking acid-reduction medication for a variety of dyspeptic complaints. All but 2 of these 15 had undergone 360 degrees fundoplication at initial repair. Two patients (4%) had late recurrent hernia, each small, demonstrated by esophagram or endoscopy. CONCLUSIONS: Laparoscopic repair in the medium term appeared durable. The incidence of postsurgical reflux symptoms was unrelated to inclusion of an antireflux procedure. In the absence of motility data, partial fundoplication was preferred, although dysphagia after floppy 360 degrees wrap was rare. With the low morbidity rate of this procedure, correction of symptomatic paraesophageal hernia appears indicated in patients regardless of age.     

Omission of the calibration bougie in laparoscopic repair of paraesophageal hernia

Background

The use of an intraesophageal bougie has traditionally been an integral step in the repair of large hiatal hernia and fundoplication. Typically, the bougie is passed by the anesthesiologist or a member of the surgical team into the stomach to enable calibration of the hiatal repair and fundoplication. An inherent risk of esophagogastric perforation is associated with this maneuver. The authors report their experience comparing symptomatic outcomes for patients who have had a large hiatus hernia repaired with and without the use of a calibration bougie.

Methods

Data were collected prospectively for 28 consecutive patients undergoing elective laparoscopic repair of a paraesophageal hernia. A bougie was used in the first 14 patients. In the next 14 patients, the use of a bougie was omitted. Symptom and quality-of-life data were collected preoperatively and 6 months postoperatively for all the patients.

Results

All the patients were satisfied with their symptomatic outcome, as reflected in their postoperative quality-of-life scores. No patients required dilation for postoperative dysphagia. There was no difference in postoperative dysphagia scores between the two groups.

Conclusion

The current series of consecutively performed laparoscopic paraesophageal hernia repairs showed no benefit in terms of symptomatic outcome associated with the use of an intraesophageal bougie. Currently, the authors’ standard practice is to perform laparoscopic repair of the paraesophageal hernia and fundoplication without the aid of a calibration bougie.