腹腔镜下巨大食管裂孔疝修补术13例分析

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。     

腹腔镜食管裂孔疝修补术的临床分析

目的：总结腹腔镜下应用补片行食管裂孔疝修补和部分胃底折叠术治疗食管裂孔疝的初步经验。方法：2007年5月至2009年12月为13例食管裂孔疝患者行腹腔镜食管裂孔疝修补术或（和）胃底折叠术。观察术后相关并发症。结果：13例手术均获成功,无中转开放手术。手术时间130-205min,平均152min,术中基本无出血。术后第2天开始饮水,第3天开始进流质饮食。术后住院4-6d。1例直接缝合者术日晚发生气胸,经胸腔穿刺抽气消失。1例胃底折叠术患者在开始进普通饮食时有轻微吞咽困难,术后1个月临床症状消失。术后随访6-12个月,平均8.5个月,行钡餐造影或CT检查均未见复发。结论：腹腔镜下应用补片和（或）胃底折叠术治疗食管裂孔疝安全有效,值得临床推广。     

腹腔镜食管裂孔疝修补术的初步探讨

目的探讨腹腔镜食管裂孔疝修补和胃底折叠术（Toupet手术）治疗食管裂孔疝的临床效果。方法 2009年1月～2010年5月,21例患者行腹腔镜食管裂孔疝（Ⅰ型9例,Ⅱ型4例,Ⅲ型6例,Ⅳ型2例）修补,采用单纯缝合膈肌脚,补片完全缝合,补片缝合加钉合等方法修补食管裂孔疝,并同期行部分胃底折叠术。结果本组患者手术均获成功,手术时间85～170min。无中转开腹及死亡病例。术后平均住院7d。术后随访1～16个月,20例临床症状完全消失,1例改善不明显,无明确复发病例。结论腹腔镜食管裂孔疝修补和胃底折叠术安全有效,应根据患者情况采用个体化的修补方式。     

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。     

腹腔镜下胃底Nissen折叠术式治疗的食管裂孔疝临床应用

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。     

四孔法腹腔镜手术治疗食管裂孔疝的疗效分析

目的:探讨四孔法腹腔镜手术治疗食管裂孔疝的安全性、可行性及临床应用价值。方法:回顾分析2010年1月至2015年1月为27例食管裂孔疝患者行四孔法腹腔镜裂孔疝修补术的临床资料,其中9例行Nissen胃底折叠术,6例行Toupet胃底折叠术,12例行Dor胃底折叠术;22例患者应用补片修补。术前患者均行食管下段括约肌压力测试,24 h p H值监测。结果:27例手术均获成功,手术时间52~105 min,平均(90.0±21.3)min;术中出血量10~20 ml,平均(12.0±2.5)ml。术后住院5~12 d,平均(7.0±1.2)d。术后随访3~60个月,平均(26.0±3.5)个月,术后症状完全消失20例,好转7例,无吞咽困难及疝复发患者。结论:四孔法腹腔镜手术治疗食管裂孔疝安全、可行、有效,术中精细操作及个体化的治疗措施可有效改善患者的生活质量,提高治愈率,减少术后并发症的发生。     

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。     

腹腔镜手术治疗食管裂孔疝的42体会

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42例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,其中32例行胃底360°折叠术(Nissen术),10例行胃底270°部分折叠术(Toupet术)。39例采用4号丝线缝合修补疝缺口,3例应用补片修补疝缺口。结果42例腹腔镜食管裂孔疝修补术全部成功。手术时间平均(138±22)min,失血平均(62±16)ml;无术后并发症;术后平均住院(5.2±1.9)d。术后症状完全消失32例(76%),好转10例(24%)。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。     

超重患者胃食管反流病的腹腔镜治疗

目的 探讨腹腔镜手术治疗超重患者胃食管反流病（gastroesophageal reflux disease,GERD）的临床效果.方法 2008年1月~2013年1月,对23例体重指数（BMI）26.1~29.7的超重GERD患者行腹腔镜治疗.单纯胃底折叠术5例（Toupet式）,18例合并食管裂孔疝者行食管裂孔疝修补加胃底折叠术（Nissen式4例,Toupet式14例）.结果 全组手术均获成功,手术时间85~225 min,平均117 min;术中出血量30~200 ml,平均70 ml;术后住院时间4~8 d,平均7 d.无中转开腹及死亡,无术后严重并发症.术后随访1~24个月,平均14个月,其中15例〉12个月,21例治愈,2例缓解.结论 腹腔镜食管裂孔疝修补和胃底折叠术治疗超重GERD患者效果满意.     

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.     

腹腔镜下巨大食管裂孔疝修补术25例

目的 探讨腹腔镜巨大食管裂孔疝修补术的临床特点和可行性.方法 2008年1月至2010年8月,应用腹腔镜治疗25例巨大食管裂孔疝,术中均使用专用补片修补食管裂孔,16例同时行胃底折叠术,记录围手术期相关指标,并随访观察治疗效果和术后复发情况.结果 25例均完成腹腔镜手术,手术85～210 min,平均106 min;术中出血量55～150 ml,平均94 ml.术后住院4～21天,平均6.8天.术后症状均得到缓解,无严重并发症,随访3～35个月,平均13.6个月,病人满意率为88%,4例出现轻度反酸症状,1例裂孔疝复发.结论 腹腔镜巨大食管裂孔疝修补术安全、可行,具有创伤小、恢复快、疗效可靠的特点,术中应用Bard CruraSoft补片可缩短手术时间,降低修补食管裂孔的难度,减少复发.

Abstract：

Objective To investigate the clinical characteristics and feasibility of laparoscopic repair of giant hiatal hernia. Methods From January 2008 to August 2010, 25 consecutive patients with giant hiatal hernia underwent laparoscopic repair. Crural closure was performed by means of two or three interrupted nonabsorbable sutures plus a tailored PTFE/ePTFE composite mesh. It was patched across the defect and secured to each crura with staples. Laparoscopic fundoplication was performed concomitantly in 16 cases according to the specific conditions of patients. Para-operative clinical parameters were recorded. All patients were routinely followed up. Clinical outcomes were collected and analyzed. Results All laparoscopic surgeries were accomplished successfully. The operating time was 85 -210 minutes (mean, 106 minutes) ,the operative blood loss was 55 - 150 ml( mean, 94 ml) ,the postoperative hospital stay was 4 -21 days( mean, 6.8 days). The symptoms in most cases were adequately relieved after operation. There was no severe postoperative morbidity. After the follow-up period of 3 - 35months ( mean, 13.6 months), the satisfaction rate of surgery was 88%. 4 cases had mild symptom recurrence of acid reflux.Hiatal hernia recurrence occurred in 1 case. Conclusions Laparoscopic repair of giant hiatal hernia is a safe and effective minimally invasive procedure, with the advantages of minimized trauma, quick recovery and reliable effect. The use of a tailored PTFE/ePTFE composite mesh ( Bard CruraSoft Mesh)for giant hiatal hernia proved to be effective in reducing the operation time and technique demands, and the rate of postoperative hernia recurrence, with a very low incidence of mesh-related complications.     

Tension-free repair of hiatal hernia during laparoscopic fundoplication: a ten-year experience

Background: The breakdown of a hiatal hernia repair can lead to clinical failure. The use of prosthetic material at the esophageal hiatus to strengthen the crural repair is relatively new and questions remain. This report examines the safety and efficacy of a tension-free crural repair with mesh.Patients and methods: Since 1993, 135 consecutive patients (19–86) [9 re-do] completed laparoscopic tension-free hiatal hernia repair prior to Nissen wrap. Esophageal hiatus was patched with a PTFE mesh (first 112 patients) or a PTFE/ePTFE composite (23 patients) secured across the defect with staples to each crura. 130 patients completed a phone questionnaire during 2003/2004 (mean f/u 64 months).Results: There have been no short-term nor long-term infections related to the PTFE mesh. Symptoms were resolved or improved and resolved with meds in 122/130 (94%). Early re-herniation occurred in one patient after vigorous exercise.Conclusions: Mesh repair/patch of the esophageal hiatus can be done without infection, with results similar to standard crural repair and consistent with surgical principles of non-tension.     

Late mesh migration through the stomach wall after laparoscopic refundoplication using a dual-sided PTFE/ePTFE mesh

We report a rare complication after laparoscopic fundoplication using a dual-sided PTFE/ePTFE (Bard® Crurasoft?) mesh fixation. A 53-year-old man was re-operated for a recurrent hiatal hernia. The hiatal hernia was reinforced using a mesh. Two years later, the patient presented with serious dysphagia and weight loss. An endoscopy revealed a migrated mesh in the stomach. The mesh was excreted within the stool without notice. The PTFE/ePTFE mesh, which is designed for treating hiatal defects, is considered to have superior tissue incorporation, together with less adhesion formation and fistulation. As mesh migration into the upper gastrointestinal tract is possible, it should be used with great care in the peri-oesophageal region.     

Composite mesh repair of a large paraesophageal hiatal hernia

We describe the first experience in Italy with a new pre-cut composite polytetrafluoroethylene (PTFE)/expanded PTFE (ePTFE) prosthesis designed for the hiatal region. A 78-year-old female patient with a large paraesophageal hiatal hernia with migration of the left transverse colon inside the hiatal defect (type IV hernia) received laparoscopic repair by means of the composite V-shaped mesh. The procedure was completed laparoscopically and a partial fundoplication was performed. A favorable outcome was assessed by barium swallow radiograms performed on postoperative day 7. A complete resolution of the symptoms was noted at follow-up 1 month postoperatively. This report confirms the feasibility, effectiveness, and added advantages of the composite V-shaped mesh in tension-free repair of a large hiatal hernia.     

平片式修补与疝环充填式修补在腹股沟疝无张力疝修补术中的选择探讨

目的探讨平片式修补与疝环充填式修补两种术式在无张力疝修补术中的适用范围。方法493例次腹股沟疝患者依据不同的疝类型,分别选择疝环充填式修补术(巴德网塞补片)及平片修补术(戈尔软组织补片、贝朗平片及巴德平片)。对手术方法、手术指征、术后疼痛、并发症及复发率等进行观察。结果男性初发性腹股沟疝(疝环2.5 cm)、女性腹股沟疝、复发性疝、嵌顿性腹股沟疝选用平片修补术,仅1例术后6个月出现迟发性感染。男性初发性腹股沟疝(疝环2.5 cm)、尤其是直疝选用疝环充填式修补术,未见术后并发症及复发病例。结论采用疝环充填式修补与平片修补的无张力疝修补术具有安全、创伤小、恢复快的优点,但应依据疝的类型选择术式及补片材料。     

Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery

Although there is evidence in the adult surgical literature to suggests that the use of mesh prosthesis during laparoscopic hiatal hernia repair results in much reduced recurrence rates, there remains a real potential for esophageal and gastric mesh erosion. A 12-year-old boy presented with esophageal obstruction from an eroded polytetrafluoroethylene prosthesis used to buttress a hiatal hernia repair 9 years earlier. A laparoscopic endogastric approach was used to remove the mesh. Great caution must be exercised in the decision to use mesh for hiatal hernia repair in children who must live with such a prosthesis for a lifetime and risk erosion. Mesh should be reserved only for those children who have extremely large defects with no chance of primary closure and for those with recurrent hernias and friable crural tissue. In all cases, the family must be informed of the potential for eventual erosion. Removal of eroded mesh using minimal access techniques can be simple and effective.     

腹腔镜食管裂孔疝修补术12例报告

目的:探讨腹腔镜手术治疗食管裂孔疝的可行性及临床价值。方法:为12例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,其中9例行胃底360度折叠术(Nissen术),3例行胃底270度部分折叠术(Toupet术)。8例使用7号丝线缝合修补疝缺口,4例应用补片修补。结果:12例手术均获成功,无一例中转开腹。手术时间62～215 min,平均(116±23)min;术中出血量10～20 ml,平均(12±2.4)ml;术后住院3～19 d,平均(5.1±1.3)d;无严重并发症发生及死亡病例。术后症状完全消失9例(75%),好转3例(25%)。结论:腹腔镜食管裂孔疝修补术安全,疗效确定,患者创伤小,值得临床应用。     

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     

高分辨率食管测压技术在腹腔镜治疗食管裂孔疝中的应用

目的探讨高分辨率食管测压（HRM）技术在腹腔镜治疗食管裂孔疝中的作用，为食管裂孔疝的诊断及手术提供临床依据。 方法回顾性分析2016年4月至2018年10月，首都医科大学附属北京朝阳医院行胃镜及HRM检查，确诊为食管裂孔疝并收住疝和壁外科的67例患者的临床资料，计算胃镜及HRM检查食管裂孔疝的确诊率，分析手术情况，总结HRM技术在腹腔镜治疗食管裂孔疝手术中的地位及作用。 结果HRM的检出率80.59%（54/67），特异性为100%（54/54）；胃镜确诊为52.24%（35/67）；其中由胃镜和HRM均确诊35例患者，约占64.81%（35/54），HRM技术的检出率明显高于胃镜；其中48例行腹腔镜治疗食管裂孔疝修补术治疗，7例患者及家属放弃手术选择内科保守治疗，12例合并其他基础疾病，保守或择期手术。 结论HRM技术能够准确、直观的描述食管裂孔疝患者胃食管压力差，确诊率高，能够有效的指导手术方案。