腹腔镜下Nissen和Toupet手术治疗小儿食管裂孔疝的近期疗效

目的 探讨腹腔镜手术治疗小儿食管裂孔疝的手术安全性和疗效.方法 2012年7月至2015年8月在腹腔镜下手术66例食管裂孔疝患儿,男41例,女25例;手术年龄1～39个月,平均(26±10)个月;体重3.2～16kg,平均(9.5±6.1)kg.所有病例术前均经消化道造影明确诊断;Ⅰ型疝(滑疝)25例,Ⅱ型疝(旁疝)37例,Ⅲ型疝(混合疝)2例,复发疝1例;手术采用腹腔镜3孔或4孔法,3-0prolene线缝合修补食管裂孔,固定食管于膈肌处,保留腹段食管3～4 cm,胃底折叠270°(Toupet) 32例或360°(Nissen) 34例.结果 所有病例均在腹腔镜下顺利完成手术,手术时间40～230 min,平均(70±25) min;术中出血2～10 mL,术后24～72 h进食,术后住院7～15 d,平均(11±2.6)d.术后随访1～37个月,出院1个月均行食管钡餐复查,未见明显疝孔形成,无呕吐症状,体重增加明显.结论 采用腹腔镜手术治疗儿童食管裂孔疝疗效好,恢复快,微创美观,安全可靠.随着手术经验的增加,开孔的数目由4孔减少为3孔,手术时间也与常规的开腹时间无明显差别.

Laparoscopic repair of paraesophageal hiatus hernia in infants and children: a review of 66 cases

Objective To explore the efficacy and safety of laparoscopic repair of paraesophageal hiatus hernia in infants and children.Methods From July 2012 to August 2015,41 boys and 25 girls underwent laparoscopic repair of paraesophageal hiatus hernias.The mean age was (26 ± 10)(1-39) months and mean weigh (9.5 ± 6.1) (3.2-16) kg.Upper gastrointestinal contrast radiography was performed.The clinical types were Ⅰ (n=25),Ⅱ (n =37),Ⅲ (n =2) and recurrent hernia (n =1).And there were Toupet (270-degree) fundoplication (n =32) and Nissen fundoplication (n =34).Results All repairs were successful without recurrence or serious complications.The mean operative duration was 70 (48-230) min,the mean volume of blood loss ＜10 ml and the mean hospital stay of 11 days.An unrestricted diet resumed at 24-72 h The postoperative follow-up period was 1-37 months.Conclusions Both safe and feasible,laparoscopic repair of paraesophageal hiatus hernia is worthy of wider clinical applications.With greater experiences,the number of open hole may decrease from 4 to 3 holes.And its operative duration has no obvious difference with that of conventional laparotomy