改良Nissen术治疗滑动性食管裂孔疝22例

发布时间：2018-01-29 18:10

本文关键词： 食管裂孔疝 Nissen手术　出处：《中国微创外科杂志》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨改良Nissen胃底折叠手术治疗滑动性食管裂孔疝的临床效果。方法 2012年3月~2017年3月我科对22例滑动性食管裂孔疝行改良Nissen术(经胸入路手术18例,腹腔镜手术4例),即胃底上提至贲门口上方2~3cm,包绕双层缝合固定食管180°,并置于膈肌下方。结果手术时间平均72 min(59~117 min),术后24~48 h进食流质饮食。除1例术后出现轻度食管返流经口服抑酸剂缓解外,其余无严重并发症及死亡,均顺利恢复出院,术后住院时间7~14 d,平均9 d。22例术后2周平卧头低位下X线钡餐检查,无胃食管反流;胃镜下食管黏膜形态分级明显优于术前(Z=-4.884,P=0.000);24 h食管pH连续监测,DeMeester评分术前(32.30±11.98)分,明显高于术后2周(5.20±2.33)分(t=11.824,P=0.000)。胃食管反流问卷调查表术前就诊时(8.5±2.3)分,明显高于术后2周(6.7±2.8)分(t=4.002,P=0.000),提示患者症状明显缓解或消失。22例随访2周~5年,中位时间32个月,未见食管裂孔疝复发,无明显反流症状。结论改良Nissen手术是治疗滑动性食管裂孔疝安全有效的方法,简化手术流程,减少标准Nissen手术包绕缝合食管360°所带来的食管狭窄并发症,同时抗反流效果也明显提高。
[Abstract]:Objective to investigate the clinical effect of modified Nissen fundus folding in the treatment of sliding esophageal hiatal hernia. From March 2012 to March 2017, 22 cases of sliding hiatal hernia were treated with modified Nissen. Transthoracic approach was performed in 18 cases. Laparoscopic surgery was performed in 4 cases, that is, the stomach fundus was raised up to 2 ~ 3 cm above the cardia, and the esophagus was fixed with double suture. It was placed under the diaphragm. Results the average operation time was 72 min(59~117. Except for one case with mild esophageal reflux relieved by oral acid suppressant, there were no serious complications and death and all patients recovered and discharged smoothly. The hospital stay was 7 days and 14 days after operation, with an average of 9 d.22 patients lying flat for 2 weeks under head and lower lower X-ray barium meal examination, no gastroesophageal reflux. The esophageal mucosal morphologic grade under gastroscopy was superior to that of pre-operation ZH4. 884 (P < 0. 000). Esophageal pH was continuously monitored at 24 h. DeMeester score was 32.30 卤11.98 before operation. It was significantly higher than that at 2 weeks after operation (5.20 卤2.33). It was significantly higher than that at 2 weeks after operation (6.7 卤2.8), indicating that the symptoms were obviously relieved or disappeared. 22 cases were followed up for 2 weeks to 5 years, with a median time of 32 months. There was no recurrence of hiatal hernia and no obvious symptoms of reflux. Conclusion modified Nissen operation is a safe and effective method for the treatment of sliding hiatal hernia and simplifies the operation procedure. The complications of esophageal stricture caused by standard Nissen procedure were reduced and the effect of anti-reflux was improved significantly.
【作者单位】：蚌埠医学院第一附属医院胸外科;
【基金】：安徽省自然科学基金项目资助(项目编号:1508085QH163)
【分类号】：R655.4
【正文快照】： 滑动性食管裂孔疝是指由于发育不良或长期腹内压增高,使食管裂孔扩大,导致腹段食管和部分胃体滑入纵隔,但有时又可恢复到腹部原位,是食管裂孔疝中最常见的一种[1]。多种慢性疾病,如冠心病、慢性胃炎、慢性支气管炎、消化性溃疡等,常与本病的临床表现相互重叠,容易造成误诊误治

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