腹腔镜下应用补片治疗食管裂孔疝3例

目的:探讨腹腔镜下应用补片修补食管裂孔疝的临床价值.方法:2007-07/2008-05我科行腹腔镜联合补片术治疗食管裂孔疝患者3例. 分析患者手术时间、术中失血量以及术后并发症, 并随访6-12mo.结果:3例患者手术顺利, 无中转开腹或开胸,手术时间分别为155、120、130 min, 术中失血量分别为50、50、70 mL, 3例患者术后第2天排气并进流质饮食, 术后第7天出院, 术后3 mo内3例患者临床症状完全消失, 随访6-12mo, 无复发病例.结论:腹腔镜下应用补片治疗食管裂孔疝临床疗效显著, 值得推广应用.     

生物补片在腹腔镜下食管裂孔疝修补术中应用中的Meta分析

目的评价治疗生物补片治疗腹腔镜食管裂孔疝修补的临床疗效食管裂孔疝中的临床疗效。 方法检索PubMed、EMbase、the Cochrane Library、万方、知网等数据库,检索时限为自建库至2020年,搜集生物补片在腹腔镜下食管裂孔疝修补术的临床对照试验,由2位研究员独立筛选文献及提取患者术前术后烧心、反流、胸痛及吞咽困难等指标的数据,采用Q检验和I²检验进行异质性评价。当异质性较大时（P＜0.05或I²＞50%）采用随机效应模型进行比较,反之采用固定效应模型。二分类变量采用相对危险度（RR）及其95％CI为效应量;连续性变量采用均数差（MD）及其95％CI表示。 结果初步检索获得相关文献435篇文献,排除重复文献、与本研究无关文章及不符合本研究结局指标的文献,最终纳入研究8篇,共纳入患者237例。Meta分析结果显示,与术前相比腹腔镜下食管裂孔疝修补术后烧灼、反流、吞咽困难等症状评分比较差异均有统计学意义（P＜0.05）,提示腹腔镜下食管裂孔疝修补术后患者烧灼感、反流、吞咽困难等症状明显缓解;腹腔镜下食管裂孔疝修补术前后胸痛症状评分比较差异无统计学意义（P＞0.05）,但从森林图可以看出代表合并后效应量的菱形坐落于右侧,提示腹腔镜下食管裂孔疝修补术后患者胸痛症状较术前减轻,但减轻效果不明显。 结论使用生物补片进行腹腔镜食管裂孔疝修补术是治疗食管裂孔疝的有效方法,是安全、有效的,明显降低术后并发症的发生。     

生物补片在腹腔镜食管裂孔疝修补术中的应用

目的探究生物补片在腹腔镜食管裂孔疝修补术中的应用效果。 方法前瞻性收集2022年1月至2023年9月在东南大学附属中大医院疝与腹壁外科就诊的60例食管裂孔疝合并胃食管反流病患者的临床资料并进行随访,所有患者均行腹腔镜食管裂孔疝修补术加胃底折叠术并且在术中应用生物补片,分别于术后第1、3、6个月进行随访,随访内容包括反酸、烧心、胸痛、呕吐、满意度、复发以及补片相关并发症,对比术前术后相关指标。 结果所有患者均顺利完成手术,无中转开腹,患者术前平均年龄（61.85±15.83）岁,平均体质量指数（24.44±3.65）kg/m²,平均手术时间（125.83±45.67）min,平均疝宽度（3.10±1.27）cm, 其中滑动性食管裂孔疝31例（51.67%）,总住院时间（9.44±3.32）d。术后平均随访（10.68±6.15）个月,术后1个月随访完成率100%,术后3个月随访完成率98.33%,术后6个月随访完成率78.33%。患者术后反酸、烧心等胃食管反流症状较术前均明显改善,术前患者总体满意度评分为中位数3（2~4）,术后6个月时患者总体满意度评分为中位数10（9~10）,术后总体满意度明显提高,差异有统计学意义（P<0.05）。共有3例患者复发,其中1例患者症状学加影像学复发,没有患者发生补片相关并发症。 结论在腹腔镜食管裂孔疝修补术中应用生物补片是有效的、安全的,在随访期间没有发生补片相关并发症,患者总体满意度高。当然,这需要更长时间的随访来进一步评估疗效。     

生物补片在腹腔镜下食管裂孔疝修补术的临床疗效分析

目的探讨生物补片在腹腔镜下食管裂孔疝修补术治疗食管裂孔疝的临床疗效。 方法回顾性收集自2014年5月至2017年3月在新疆维吾尔自治区人民医院住院治疗并使用生物补片行腹腔镜下食管裂孔疝修补术患者12例临床资料,总结上述患者术前及术后12个月反流情况及术后并发症等。 结果12例患者均手术顺利无中转术式等情况,术后患者反流症状均较术前明显改善,术前反流时间、反流次数、DeMeester评分、GERD-Q量表评分等比术后明显降低,差异有统计学意义(P<0.05),术后出现早期吞咽困难2例,随访过程中无严重并发症发生,无复发。 结论使用生物补片进行腔镜食管裂孔疝修补联合胃底折叠术是治疗食管裂孔疝的有效方法,短期随访结果说明生物补片加强修补食管裂孔疝是安全、有效的,长期疗效需进一步研究证实。     

腹腔镜食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝合并胃食管反流的临床疗效观察

目的观察腹腔镜食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝合并胃食管反流的临床疗效。方法选择2015-02~2016-04该院收治的80例食管裂孔疝合并胃食管反流患者,按随机数字表法分为两组,各40例。对照组实施常规开腹手术治疗,观察组实施腹腔镜食管裂孔疝修补联合胃底折叠术治疗。比较两组患者各项手术指标、生存质量、并发症发生情况以及术后病情状况。结果观察组术中出血量、胃肠道功能恢复时间、手术时间、住院时间均短于对照组,差异有统计学意义(P0.01);观察组胸痛、烧心感、反食、反酸评分均低于对照组,差异有统计学意义(P0.01);观察组GLQI评分与对照组相比有明显提高,差异有统计学意义(P0.01);观察组并发症发生率明显低于对照组,差异有统计学意义(P0.05)。结论对食管裂孔疝合并胃食管反流患者实施腹腔镜食管裂孔疝修补联合胃底折叠术治疗能有效优化各项手术指标,改善患者病情,提高患者生存质量,降低术后并发症发生率,安全性高,值得临床推广。     

基层医院开展腹腔镜下食管裂孔疝修补术的前景分析

目的评价基层医院开展腹腔镜下食管裂孔疝修补术的临床效果及前景分析。 方法回顾性分析2013年5月至2017年1月库车县人民医院行腹腔镜下食管裂孔疝修补术的8例患者的手术效果及预后。 结果8例患者均采用腹腔镜食管裂孔疝修补术加胃底折叠术(Nissen)360°胃底折叠术,其中2例使用双面合成补片,2例使用生物补片,术后反流性食管炎症状如：胸骨后灼烧样疼痛、反酸、嗳气完全缓解。无中转开腹、手术并发症、死亡。术后随访12～48个月,8例患者术后均无复发症状。复查胃镜,食管炎症及溃疡完全治愈。 结论腹腔镜食管裂孔疝修补术在具备腹腔镜设备条件及技术水平的基层医院有广阔的应用前景。     

达芬奇机器人与腹腔镜手术治疗食管裂孔疝的临床疗效比较

目的比较达芬奇机器人与传统腹腔镜手术治疗食管裂孔疝的临床疗效。 方法回顾性分析2021年12月至2023年12月天津市南开医院行达芬奇机器人手术（38例）和传统腹腔镜手术（42例）食管裂孔疝患者的临床资料。比较2组患者手术情况、术后临床终点指标及术后并发症发生情况。 结果与传统腹腔镜组比,机器人组手术时间略长,差异有统计学意义（P<0.05）;2组患者术中出血量、术后进食时间、术后住院时间、总住院费用、总住院时间比较差异均无统计学意义（均P>0.05）;随访1~12个月,生活质量评分比较差异均无统计学意义（均P>0.05）。 结论达芬奇机器人手术治疗食管裂孔疝是安全有效的,其在术中出血量、术后进食时间、术后住院时间、总住院费用、总住院时间、术后并发症方面对比传统腹腔镜手术无明显差异。     

腹腔镜技术在巨大食管裂孔疝修补联合抗反流手术中的临床疗效分析

目的探讨腹腔镜下巨大食管裂孔疝修补术临床经验和疗效。 方法回顾性分析新疆维吾尔自治区人民医院,2013年7月至2016年2月住院并行腹腔镜下巨大食管裂孔疝修补联合胃底折叠术27例患者临床资料,总结上述患者术前、术后1年24 h食管pH监测、高分辨率食管测压及术后并发症等情况。 结果手术时间98～150 min,术中平均出血量(50.1±22)ml,术后6～12 h拔出胃管,术后平均住院时间(4.5±2.1)d,患者术后反流症状明显改善,合并有贫血、哮喘的患者相关症状明显好转。术后无严重并发症发生,随访过程中无复发病例。 结论腹腔镜下食管裂孔疝修补联合抗反流手术是治疗巨大食管裂孔疝的有效术式,具有创伤小、恢复快等特点,可作为反流症状明显的巨大食管裂孔疝患者治疗的首选,值得临床推广。     

食管裂孔疝的治疗进展

食管裂孔疝是消化系统常见病,随着腹腔镜及内镜技术的飞速发展,该病的治疗方案也在不断更新,主要分为以下几种：一般治疗、药物治疗、外科手术治疗、内镜微创治疗。不同的治疗方式均有不同的适应症及利弊,因此,为了达到更好的治疗效果,本文就食管裂孔疝的治疗现状作一综述。     

食管裂孔疝并发症的手术治疗

1992年4月至1995年6月,我科手术治疗食管裂孔疝并发症4例,其中滑脱疝2例,引起食管狭窄及Ｂａｒｒｅｔｔ食管各1例;混合疝2例,胃大部疝入右胸及全胃疝入左胸各1例。1　临床资料例1,男,3.5岁,食后即吐3.5年,进行性吞咽困难伴间断发热、黑便2年。入院前1年在外院行“左侧剖胸食管裂孔疝修补术”。入院前19天唾液亦不能咽下。胃镜:食管粘膜萎缩糜烂,距门齿16ｃｍ食管狭窄不能通过。1993年10月14日沿原切口入胸:贲门及部分胃底于膈上,食管裂孔约3.0ｃｍ,主动脉弓以下食管增粗纤维化。切除病变食管,行食管胃主动脉弓上吻合包埋缝缩术[1]:围巾式包…     

Laparoscopic mesh repair antireflux surgery for treatment of large hiatal hernia

SUMMARY: One of the most frequently occurring anatomic failures after laparoscopic fundoplication is migration of the wrap into the chest, with or without disruption. This so-called 'slipped' Nissen fundoplication may be the result of inadequate closure of the diaphragmatic crura or rupture of the sutures or disruption of the muscle fibers approached. From January 2000 to December 2002, a total of seven patients (four male) with a mean age of 56 years (range 22-72 years), were considered for laparoscopic antireflux procedure using DACRON mash to reinforce the crural hiatal closure. The patients were operated under general anesthesia; laparoscopy was performed by classical approach with five trocars. The mean operative time was 120 minutes (range 40-240 min). There were no deaths. The average of postoperative hospital stay was 3.5 days (range, 3-5). Patients returned to normal activities usually on postoperative day 10 (range, 7-15). The follow-up time was at least 2 years. There was only one late complication related to the use of DACRON mesh at the hiatus, due to migration of the mesh into the esophageal lumen causing disphagia. In conclusion the mesh repair antireflux surgery is a good alternative for closing the diaphragmatic defect in large hiatal hernias or to correct this problem in case of recurrence or Barrett's esophagus.     

Laparoscopic giant parastomal hernia repair with prosthetic mesh

Laparoscopy is being increasingly used in colorectal surgery interventions. Herein, we present a patient with giant parastomal hernia who underwent laparoscopic repair. A70-year-old man who had undergone abdominoperineal resection and end colostomy for carcinoma of rectum was admitted to our clinic with a giant parastomal hernia. The parastomal hernia was repaired by laparoscopic approach using prosthetic material. The patient was discharged uneventfully on postoperative day 4. Laparoscopic approach is a rational alternative to conventional repair techniques of parastomal hernia and may be a reliable and easily applicable method with the classic benefits of laparoscopic surgery. Received: 14 May 2002 / Accepted: 24 August 2002     

Approaches to the diagnosis and grading of hiatal hernia

Hiatus hernia refers to conditions in which elements of the abdominal cavity, most commonly the stomach, herniate through the oesophageal hiatus into the mediastinum. With the most common type (type I or sliding hiatus hernia) this is associated with laxity of the phrenooesophageal membrane and the gastric cardia herniates. Sliding hiatus hernia is readily diagnosed by barium swallow radiography, endoscopy, or manometry when greater than 2 cm in axial span. However, the mobility of the oesophagogastric junction precludes the reliable detection of more subtle disruption by endoscopy or radiography. Detecting lesser degrees of axial separation between the lower oesophageal sphincter and crural diaphragm can only be reliably accomplished with high-resolution manometry, a technique that permits real time localization of these oesophagogastric junction components without swallow or distention related artefact.     

Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach

Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of...     

Dual-sided composite mesh repair of hiatal hernia: Our experience and a review of the Chinese literature

AIM:To summarize our experience in the application of Crurasoft for antireflux surgery and hiatal hernia(HH)repair and to introduce the work of Chinese doctors on this topic.METHODS:Twenty-one patients underwent HH repair with Crurasoft reinforcement.Gastroesophageal reflux disease(GERD)and HH-related symptoms including heartburn,regurgitation,chest pain,dysphagia,and abdominal pain were evaluated preoperatively and 6mo postoperatively.A patient survey was conducted by phone by one of the authors.Patients were asked about"recurrent reflux or heartburn"and"dysphagia".An internet-based Chinese literature search in this field was also performed.Data extracted from each study included:number of patients treated,hernia size,hiatorrhaphy,antireflux surgery,follow-up period,recurrence rate,and complications(especially dysphagia).RESULTS:There were 8 typeⅠ,10 typeⅡand 3 typeⅢHHs in this group.Mean operative time was 119.29min(range 80-175 min).Intraoperatively,length and width of the hiatal orifice were measured,(4.33±0.84and 2.85±0.85 cm,respectively).Thirteen and eight Nissen and Toupet fundoplications were performed,respectively.The intraoperative complication rate was9.52%.Despite dysphagia,GERD-related symptoms improved significantly compared with those before surgery.The recurrence rate was 0%during the 6-mo follow-up period,and long-term follow-up disclosed a recurrence rate of 4.76%with a mean period of 16.28mo.Eight patients developed new-onset dysphagia.The Chinese literature review identified 12 papers with213 patients.The overall recurrence rate was 1.88%.There was no esophageal erosion and the rate of dysphagia ranged from 0%to 24%.CONCLUSION:The use of Crurasoft mesh for HH repair results in satisfactory symptom control with a low recurrence rate.Postoperative dysphagia continues to be an issue,and requires more research to reduce its incidence.     

小切口腹股沟疝补片修补术应用价值探讨

目的探讨小切口腹股沟疝补片修补术的应用价值。方法前瞻性随机对照研究176例成人腹股沟疝手术,其中58例行小切口腹股沟疝补片修补术,65例行疝环充填式无张力疝修补术(MPH),53例行全腹膜外腹腔镜疝修补术(TEP),比较三组病例的切口长度、手术时间、住院费用、术后恢复时间、手术并发症、复发率等。结果三组病例的切口长度、术后复发率、手术时间、住院费用和术后恢复时间比较差异有统计学意义(P0.05),小切口腹股沟疝补片修补组平均切口长度(3.7±0.8)cm,术后复发率最低;MPH组切口最长、手术时间最短;TEP组手术时间最长、费用最高,但切口最短、术后恢复时间最短。三组的手术并发症发生率差异无统计学意义(P0.05)。结论三种手术方式各有特点,对不适于TEP而腹横筋膜薄弱并有高度复发因素的腹股沟疝患者,尤其老年瘦弱者,小切口腹股沟疝补片修补术是更好的选择。     

食管裂孔疝患者食管蠕动功能的变化

目的探讨食管裂孔疝患者食管蠕动功能的改变在胃食管反流中的意义。方法选择32例有胃食管反流症状患者(单纯食管裂孔疝10例、食管裂孔疝合并食管炎12例、单纯食管炎10例)和9例无反流症状的对照组,分别测定其下食管括约肌(LES)压力、食管的蠕动波幅、蠕动时限、蠕动速度,并经内镜对患者食管炎的程度进行分级。结果裂孔疝合并食管炎组、单纯食管炎组其LES压力较对照组均降低,单纯裂孔疝组LES压力较对照组降低,但无统计学差异。食管近端及远端的蠕动波幅食管裂孔疝组最高,达(51.3±5.4)mmHg和(83.6±8.3)mmHg,食管炎组最低;食管近远端的蠕动时限各组间无统计学差异;而食管远端的蠕动速度裂孔疝组也最高,食管炎组低于对照组。结论食管裂孔疝患者食管蠕动功能在胃食管反流、粘膜损伤的发生发展中起着重要的作用。     

儿童先天性食管裂孔疝伴食管狭窄的综合治疗策略探讨

目的探讨先天性食管裂孔疝导致食管狭窄患儿的食管扩张与食管支架放置、外科手术等综合治疗方法的选择时机及疗效。方法对北京军区总医院2009年12月-2012年9月混合型先天性食管裂孔疝伴严重食管狭窄的9例患儿的临床资料及治疗方案进行分析。结果 9例诊断混合型食管裂孔疝患儿食管扩张后因症状无改善行贲门胃底折叠术,术后放置食管支架,9例患儿术后贲门功能均恢复正常,吞咽困难消失。结论对于伴严重食管狭窄的混合型先天性食管裂孔疝患儿应早期手术治疗,术后辅以食管支架治疗,可达到满意效果。