腹腔镜疝修补联合Nissen与Dor胃底折叠术治疗老年食管裂孔疝的对照研究-现代医学

腹腔镜疝修补联合Nissen与Dor胃底折叠术治疗老年食管裂孔疝的对照研究

单位：1. 民航总医院心胸外科, 北京 100022;
2. 北京同仁医院胸外科, 北京 100022

分类号：R655.6

出版年·卷·期（页码）：2018·46·第二期（168-172）

摘要：

目的：对比研究腹腔镜疝修补联合Nissen与Dor胃底折叠术治疗老年食管裂孔疝（HH）的疗效。方法：回顾分析149例行腹腔镜疝修补术并抗反流术的HH患者的临床资料，其中，94例行腹腔镜疝修补术联合Nissen胃底折叠术治（NisseNissen组），55例行腹腔镜疝修补术联合Dor胃底折叠术（Dor组）。比较两组手术情况、术后并发症，术前及术后6个月评价反流症状为主的问卷调查（Gerd Q）、DeMeester评分和消化病生存质量指数（QLQI）。结果：Nissen组的手术时间及术中出血量明显高于DOR组（P<0.05），但两组术后胃肠道功能恢复时间、术后住院时间比较差异无统计学意义（P>0.05）；两组术后6个月GERD-Q、DeMeester评分均显著降低，GLQI评分均显著提高（P<0.05），组间轻中度患者术后各项评分比较差异无统计学意义（P>0.05），但Nissen组重度患者的各项评分均显著优于DOR组（P<0.05）；Nissen组吞咽困难发生率为15.96%，显著高于Dor组的3.64%（P<0.05）。结论：腹腔镜疝修补联合Nissen与Dor胃底折叠术治疗老年HH均安全有效，Dor胃底折叠术后吞咽困难发生率更低，Nissen胃底折叠术对重度食管酸反流患者的抗反流效果更好。

Objective: To compare the efficacy of laparoscopic hernia repair combined with Nissen and Dor fundoplication in the treatment of senile esophageal hiatal hernia(HH). Methods: The clinical data of 149 patients with HH who underwent laparoscopic hernia repair and anti-reflux were retrospectively analyzed,including 94 patients of laparoscopic hernia repair combined with Nissen fundoplication(Nissen group),and 55 patients of laparoscopic hernia repair combined with Cor fundoplication(Cor group).The surgical condition and the postoperative complications between the two groups were compared,the scores of Gerd Q, DeMeester and QLQI were evaluated before surgery and 6 months after surgery. Results: The operation time and intraoperative blood loss in Nissign group were significantly higher than those in Dor group(P<0.05),but there was no significant difference in the recovery time and postoperative hospital stay between the two groups(P>0.05); 6 months after surgery, scores of GERD-Q and DeMeester were significantly decreased GLQI scores were significantly improved in the two groups(P<0.05),there was no significant difference of GERD-Q, DeMeester and GLQI scores in mild-moderate patients between the two groups(P>0.05),but these scores in severe patients in Nissen group were significantly better thanthose of the Dor group(P<0.05);The incidence of dysphagia in the Nissen group was 15.96%, significantly higher than 3.64% in the Dor group(P<0.05). Conclusion: Laparoscopic hernia repair combined with Nissen and Dor fundoplication safe and effective in the treatment of elderly patients with HH. Dor fundoplication has less postoperative dysphagia,while Nissen fundoplication has better curative effect for patients with severe esophageal acid reflux.

参考文献：

[1] 王春赛尔,谢鹏雁.食管裂孔疝的发病机制及诊断方法[J].中国医刊,2015,50(1):26-31.
[2] 姚丹,任泽强,张蓬波,等.腹腔镜下Nissen胃底折叠术治疗老年食管裂孔疝效果的临床分析[J].中国普外基础与临床杂志,2016,23(3):319-323.
[3] 苏福增,张成,克力木,等.腹腔镜Nissen、Toupet和Dor胃底折叠术治疗食管裂孔疝合并胃食管反流病的疗效对比分析[J].中华胃肠外科杂志,2016,19(9):1014-1020.
[4] 钱家鸣.消化内科学[M].第2版.北京:人民卫生出版社,2015:358-362.
[5] 王志,张成,克力木,等.GERDQ量表在胃食管反流病诊断中的应用[J/CD].中华胃食管反流病杂志,2014,1(1):36-38.
[6] PALESCH Y Y,HEBERT R L,MCDANIEL L K,et al.Digestive disease quality of life instrument(DDQ-15):A validation study[J].Gastroenterology,1998,114(4):A32-A33.
[7] 杨玉兵,王耿泽,张海洋,等.腹腔镜食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝[J].中国普通外科杂志,2014,23(12):1730-1732.
[8] 郝志鹏,蔡奕欣,付圣灵,等.全腹腔镜食管裂孔修补及Nissen胃底折叠新技巧治疗食管裂孔疝疗效分析[J].临床外科杂志,2017,25(1):51-54.
[9] 李义亮,张成,克力木,等.腹腔镜短松Nissen胃底折叠术治疗食管裂孔疝合并胃食管反流病的疗效分析[J].中华胃食管反流病电子杂志,2015,2(4):202-205.
[10] MICKEVCIUS A,ENDZINAS Z,KIUDELIS M,et al.Influence of wrap length on the effectiveness of Nissen and Toupet fundoplieations:5-year resuits of prospective,randomized study[J].Surg Endosc,2013,27(3):986-991.
[11] 杜航向,谭戈文,杨治力,等.腹腔镜Nissen与Toupet胃底折叠术式治疗胃食管反流病疗效比较的Meta分析[J].中华胃肠外科杂志,2012,8(1):814-818.
[12] RAUE W,ORDEMANN J,JACOBI C A,et al.Nissen versus Dor fundoplication for treatment of gastroesophageal reflux disease:a blinded randomized clinical trial[J].Dig Surg,2011,28(1):80-86.
[13] REBECCHI F,GIACCONE C,FARINELLA E,et al.Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia:long-term results[J].Ann Surg,2008,248(6):1023-1030.
[14] BROEDERS J A,ROKS D J,AHMED A U,et al.Laparoscopic anterior 180 degree versus nissen fundoplication for gastroesophageal reflux disease:Systematic review and meta-analysis Randomized clinical trials[J].Ann Surg,2013,257(5):850-859.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录