腹腔镜食管裂孔疝修补术8例报告

目的:总结腹腔镜手术治疗食管裂孔疝的经验。方法:回顾分析2004年5月至2009年3月我院采用腹腔镜手术治疗8例食管裂孔疝患者的临床资料,其中食管旁疝(Ⅱ型)3例,混合型疝(Ⅲ型)5例,伴有轻度胃食管返流2例,中度或重度6例。行食管裂孔修补+Toupet胃底折叠术4例,食管裂孔修补+Nissen 360°胃底折叠术4例,其中2例行专用补片修补术。结果:8例患者均顺利完成手术,无中转开腹或开胸手术。手术时间2.2～6.5h,平均3.2h,术后1例发生一过性皮下气肿,2例出现暂时性吞咽困难,均经保守治疗缓解,全组患者原有症状均明显好转或完全消失。术后住院4～16d,平均10d,随访10～26个月,平均18个月,无复发。结论:腹腔镜手术治疗食管裂孔疝具有患者创伤小、康复快等特点,临床效果满意,值得推广。

Laparoscopic repair of esophageal hiatal hernia:with a report of 8 cases

Objective:To summarize the clinical experience of laparoscopic repair of esophageal hiatal hernia.Methods:We retrospectively analyzed clinical data of 8 cases of esophageal hiatal hernia treated by laparoscopic surgery from May 2004 to March 2009 in our hospital.There were 3 cases of type Ⅱ hernia,5 cases of type Ⅲ hernia (with mild gastroesophageal reflux in 2 cases,moderate or severe in 6 patients).Surgical procedures included hernia repair plus Toupet partial fundoplication in 4 cases and hernia repair plus Nissen total fundoplication in 4 cases (2 cases using special hernia mesh).Results:Eight cases of operations were successful,no conversion to open surgery occurred in this study.The operative time ranged 132-390min (mean 192min).Complications included 1 case of subcutaneous emphysema and 2 cases of transient dysphagia,all of which recovered by the conservative treatment.The symptoms markedly improved or disappeared completely.The postoperative hospital stay was 4-16 days(mean 10 days).All the patients were followed up for 10-26 months(mean 18 months).No recurrence was found.Conclusions:Laparoscopic surgery in the treatment of esophageal hiatal hernia has features of less trauma and quick restore,clinical results are satisfactory,it is worth being applied extensively.