腹腔镜下食管裂孔疝修补加胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床观察

发布时间：2018-03-30 18:44

  本文选题：胃食管反流病　切入点：食管裂孔疝　出处：《郑州大学》2017年硕士论文

【摘要】：目的对比分析腹腔镜下食管裂孔疝修补联合Nissen、Toupet和Dor手术对食管裂孔疝合并胃食管反流病的手术效果,探讨各自术式优势。方法收集郑州大学第一附属医院惠济院区及合作单位病例2013-2016年共计215例,所有患者手术方式包括腹腔镜下食管裂孔疝修补术,抗反流手术为三种方式,其中行Nissen手术治疗60例,行Toupet手术治疗83例,行Dor手术治疗72例。回顾性分析三组患者一般情况、手术时间、术后并发症,以及患者术前、术后3月、术后6月的胃食管反流病症状评分(Gerd-Q评分表)、食管24小时Ph阻抗监测、高分辨率食管压力测定、电子胃镜检查结果。结果三组患者随访时间3~36个月,平均13个月。入组患者年龄、性别、BMI、反流症状病程、PPI药物服用疗程及平均住院天数均无统计学差异。食管裂孔疝修补术+Dor手术时长明显小于其他两种手术方式,结果具有显著性(P0.05)。三组术式并发症比较,食管裂孔疝修补术+Nissen手术术后并发腹胀及吞咽困难几率明显高于其他两种术式,结果有统计学差异(P=0.005,P=0.004)。分析指标标准对比:三组患者均于术后3月随访GERD-Q表,术后6月复查食管24小时Ph阻抗监测、高分辨率食管压力测定、电子胃镜。三组患者GERD-Q术后3个月与术前相比,均明显降低(P0.05),三种手术之间手术效果无差异(P=0.149)。三组患者术后6个月复查食管测压、食管测酸及胃镜结果均较术前有明显改善,(P0.05),且三种手术方式之间无明显差异(P0.05)。结论腹腔镜下食管裂孔疝修补术加抗反流手术,包括Nissen、Toupet、Dor胃底折叠术均为治疗HH合并GERD的有效、创伤小、恢复快的手术方式。三种手术方式均可以达到控制反流相关症状的效果,Dor以其手术时间短,术中出血少,不改变原有解剖结构,便于临床操作,值得临床推广。
[Abstract]:Objective to compare and analyze the effect of laparoscopic repair of hiatal hernia combined with nissenn Toupet and Dor in the treatment of hiatal hernia with gastroesophageal reflux disease (GERD).Methods A total of 215 patients in Huiji Hospital and cooperating Unit of the first affiliated Hospital of Zhengzhou University were collected from 2013 to 2016. All the patients underwent laparoscopic repair of esophageal hiatal hernia and three ways of anti-reflux surgery. Among them, 60 cases were treated with Nissen operation.83 cases were treated with Toupet and 72 cases with Dor.The general condition, operation time, postoperative complications, and the symptom scores of gastroesophageal reflux were analyzed retrospectively in the three groups. The symptom scores of gastroesophageal reflux were evaluated by Gerd-Q scale and 24 hour Ph impedance monitoring before operation, 3 months after operation and 6 months after operation.High resolution esophageal pressure measurement and electronic gastroscopy.Results the follow-up time was 3 ~ 36 months (mean 13 months).There was no significant difference in age, sex, duration of reflux and PPI course of treatment and average hospitalization days.The length of Dor in repair of esophageal hiatal hernia was significantly longer than that of the other two methods, and the result was significant (P 0.05).The incidence of abdominal distension and dysphagia after Nissen operation was significantly higher than that of the other two groups. The results showed that there was a significant difference between the two groups in the incidence of abdominal distension and dysphagia.Three groups of patients were followed up with GERD-Q table at 3 months after operation, and 24 hours Ph impedance monitoring, high resolution esophageal pressure measurement and electronic gastroscopy were reexamined 6 months after operation.Three months after GERD-Q, all the patients in the three groups were significantly lower than those before operation (P 0.05), and there was no difference in the results of the three kinds of operations (P < 0. 149).Six months after operation, esophageal manometry was reexamined in the three groups. The results of esophageal acid and gastroscopy were significantly improved compared with those before operation (P 0.05), and there was no significant difference among the three kinds of operation methods (P 0.05).Conclusion Laparoscopic repair of esophageal hiatal hernia combined with anti-reflux surgery, including Nissentor Toupetor fundus folding, is an effective method for the treatment of HH with GERD.All the three kinds of operation methods can control the symptoms of reflux. Dor is worth popularizing because of its short operation time, less bleeding during operation, no change of the original anatomical structure, and convenient for clinical operation.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R655.4
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本文编号：1687161