食管裂孔疝合并胃扭转的腹腔镜手术治疗
Laparoscopic surgery for hiatal hernia with gastric volvulus
关磊 1聂玉胜 1杨慧琪1
作者信息
- 1. 首都医科大学附属北京朝阳医院疝和腹壁外科,北京 100043
- 折叠
摘要
目的 探讨腹腔镜治疗食管裂孔疝合并胃扭转的可行性及安全性.方法 回顾性分析2021年6月至2022年12月首都医科大学附属北京朝阳医院收治的29例食管裂孔疝合并胃扭转患者的临床资料,术前均诊断明确,其中26例为食管裂孔疝合并慢性胃扭转患者,3例合并急性胃扭转经有效保守治疗后手术,以上均择期行腹腔镜下食管裂孔疝修补术,术中均放置补片,根据食管动力情况行胃底折叠术,对患者的术前基本情况、手术时间、术中出血量、胃疝出比例、疝分型、胃扭转分类、中转开腹情况、术后住院时间、术后并发症、症状改善率及术后满意度进行分析.结果 29例患者最常见的主诉为慢性梗阻症状,均在腹腔镜下顺利完成手术,无中转开腹病例,其中Ⅲ型疝最常见为19例(65％),器官轴性胃扭转最常见为20例(70％).平均手术时间(110.2±33.3)min,平均术中出血量(12.6±7.0)ml,平均胃疝出比例75.9％±15.8％,平均疝环缺损长度(6.6±1.2)cm,平均疝环缺损宽度(5.0±1.1)cm.术后平均住院时间(6.4±1.7)d,围手术期发生肺部感染2例(7％),肺不张2例(7％),胃动力障碍1例(3％).术后均治愈出院,随访15～32个月,未发生补片感染、长期慢性疼痛、肠梗阻、疝复发等严重并发症,术后症状改善率90％,术后满意度90％.结论 腹腔镜手术治疗食管裂孔疝合并胃扭转安全、可行,疗效可靠.
Abstract
Objective To evaluate the feasibility and safety of laparoscopic surgery of hiatal hernia with gastric volvulus.Methods A retrospective study was conducted to analyze the clinical data of 29 cases of hiatal hernia with gastric volvulus undergoing laparoscopic mesh repair and fundoplication at Beijing Chao-Yang Hospital from Jun 2021 to Dec 2022.Fundoplication was performed according to esophageal motility.The general data,operation times,intraoperative blood loss,percentage of intrathoracic stomach,hernia and gastric volvulus classification,conversion to open surgery,post-operative hospital stay and complications,symptom improvement rate,post-operative satisfaction were analyzed.Results Chronic obstruction symptoms were the most common complaint among the 29 patients.All the operations were done laparoscopicaly with no conversion case,19(65％)cases with type Ⅲ hiatal hernia,20(70％)cases with organoaxial gastric volvulus,average operating time was(110.2±33.3)min,average blood loss was(12.6±7.0)ml,percentage of intrathoracic stomach 75.9％±15.8％,length of hernia defect was(6.6±1.2)cm,width of hernia defect was(5.0±1.1)cm.Average post-operative hospital stay was(6.4±1.7)days,perioperative complications were pneumonia(7％),atelectasis(7％)and gastric motility disorder(3％).All the patients were followed up for 15 to 32 months,without report of patch infection,long-term chronic pain,intestinal obstruction and hernia recurrence.Postoperative symptom improvement rate was 90％,postoperative satisfaction rate was 90％.Conclusion Laparoscopic surgery of hiatal hernia with gastric volvulus is a safe,feasible and effective method with satisfactory results.
关键词
疝,食管裂孔/胃扭转/疝修补术/腹腔镜Key words
Hernia,hiatal/Stomach volvulus/Herniorrhaphy/Laparoscopy引用本文复制引用
基金项目
北京市卫生健康委首都卫生发展科研专项自主创新项目(首发2020-2-2035)
出版年
2024
NETL
NSTL
万方数据