食管裂孔疝手术方式的对比研究
食管裂孔疝；手术治疗,,食管裂孔疝；手术治疗,1资料与方法,2结果,3讨论,【参考文献】
【摘要】 目的 总结手术治疗食管裂孔疝的经验和体会，探讨不同的手术方法对食管裂孔疝的治疗效果，阐述手术治疗食管裂孔疝的发展方向。方法 本组112例病人中95例经腹手术：典型的Nissen手术27例，短松式Nissen手术39例，Hill手术17例，Boerema手术9例，Rampal手术3例，经胸手术17例：Belsey Mark Ⅳ手术8例，Collis- Nissen手术5例，Sweet手术4例；经内镜胃黏膜折叠成形术7例为滑动型疝。结果 术后死亡1例。经腹手术病人中7例出现术后并发症：典型的Nissen手术咽下困难2例，反酸1例；短松式Nissen手术反酸1例，Hill手术吞咽困难、反酸各1例， Rampal手术反酸1例；经胸手术病人5例出现术后并发症。 52例经胸、腹手术病人术后随访，效果优者33例(63.5%)，良者12例(33%)，欠佳者4例(7.2%)，差者3例(5.8%)。比较典型的Nissen和短松式Nissen两组术后并发症发生差异有显著性(P<0.05)。经内镜胃黏膜折叠成形术患者5例症状完全消失，余2例症状得到明显改善。结论 (1)滑动型疝在发生胃食管反流时可引起诸多并发症应积极手术治疗；(2)经胸手术入路损伤大，并发症多，滑动型疝不宜采用此手术方案；(3)腹腔镜或内镜治疗将成为今后发展方向。【关键词】 食管裂孔疝；手术治疗
The study of the surgical treatment of hiatus hernia
YU Lei,LI Jian-ye,JIANG Jian.Department of Thoracic Surgery,Tongren Hospital,Beijing 100730,China
【Abstract】 Objective Through reviewing the surgical experience in the treatment of hiatus hernia, we evaluate the effectiveness of the different antireflux procedures and provide the operative approach of choice for treating hiatus hernia.Methods Of all the patients, there were 95 undergoing the transabdominal surgery: 27 patients were in the Nissen group, 39 in the floppy Nissen group, 17 in the Hill group,9 in the Boerema group, 3 in the Rampal group; And there were 17 patients undergoing the transthoracic surgery: 8 patients were in the Belsey Mark Ⅳ group, 5 in the Collis- Nissen group, 4 in the Sweet group; Endoscopic gastroplasty has been performed in 7 patients with sliding hiatus hernia. Results There is one case postoperative death. Complications occurred in 7 patients undergoing the transabdominal surgery: In the Nissen group, 2 patients suffered from severe dysphagia and 1 from regurgitation; In the floppy Nissen group, 1 patients had regurgitation; In the Hill group, there were one having severe dysphagia and one having regurgitation. There was significant difference in complication between the Nissen group and the floppy Nissen group. 5 patients undergoing the transthoracic surgery had complications. At last follow-up, excellent functional results were observed in 33 patients (63.5%), good in 12(33%), fair in 4(7.2%), poor in 3(5.8%). Of the 7 patients treated with the endoscopic gastroplasty, there were 5 whose symptoms have disappeared and 2 whose symptoms have improved greatly. Conclusion (1)Surgery should be performed in some of patients with sliding hiatus hernia having severe symptoms and complications;(2)Due to more serious trauma and more complications, the transthoracic surgery should not be used in patients with sliding hiatus hernia;(3)Minimally invasive surgery, such as laparoscopes and endoscopes, will become the direction to the treatment of hiatus hernia. ......
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