腹腔镜手术治疗小儿食管裂孔疝的手术体会

目的探讨腹腔镜手术治疗小儿食管裂孔疝部分中转开腹手术的原因及经验。方法2003年6月至2013年9月作者对85例食管裂孔疝患儿施行腹腔镜食管裂孔疝修补术联合胃底折叠术。对4例合并腹股沟斜疝患儿同时行腹腔镜疝囊高位结扎术。1例患儿合并有肥厚性幽门狭窄及回肠憩室畸形。结果 85例患儿均行腹腔镜下食管裂孔疝修补联合胃底折叠术(82例Nissen法,3例thal法),其中10例中转开腹手术。手术时间100~210 min,平均手术时间(160 25)min,随访两年无一例复发。结论腹腔镜治疗食管裂孔疝创伤小,疗效确切,可以联合治疗其他疾病。有腹部手术史,食管裂孔疝巨大,膈肌发育不良,严重出血和腹腔粘连是中转开腹手术的重要原因。掌握好中转开腹指征,可以减少并发症的发生。

Laparoscopy in the treatment of children with hiatal hernia:a report of 85 cases

Objective To explore the rationales and experiences of laparoscopy in the treatment of chil-dren with hiatal hernia. Methods From June 2003 to September 201 3,85 children with hiatal hernia under-went laparoscopic repair with fundoplication. Four cases of inguinal hernia underwent laparoscopic repair of in-direct inguinal hernia. One case was complicated with hypertrophic pyloric stenosis and deformity of ileal diver-ticulum. Results In this cohort,75 cases were successfully operated. The average operative duration was (1 60 ±25 )(1 00 ~21 0 )min. There was no recurrence during follow-ups. Conclusions Laparoscopy of e-sophageal hernia offers the advantages of minimal trauma,definite efficacy and feasible dealing with other con-current conditions. History of abdominal surgery,large esophageal hernia,diaphragmatic muscular develop-ment,severe hemorrhage and abdominal adhesion are major causes of converting into open surgery. Mastering the indications of conversion reduces the incidence of complications.