食管裂孔疝修补联合食管胃隧道式折叠膈顶悬吊固定术治疗胃食管反流病的临床疗效

Clinical efficacy of hiatal hernia repair combined with tunneled esophagogastric fundoplication and diaphragmatic dome suspension‑fixation in the treatment of gastroesophageal reflux disease

    摘要
  • 摘要:
    探讨腹腔镜食管裂孔疝修补联合食管胃隧道式折叠膈顶悬吊固定术（HHR⁃TEF⁃DDSF）治疗胃食管反流病的临床疗效。
    采用回顾性描述性研究方法。收集2024年10月至2025年6月南京医科大学附属逸夫医院收治的32例胃食管反流病患者的临床资料；男20例,女12例；年龄为（68±7）岁。患者均行腹腔镜HHR‑TEF‑DDSF。观察指标：（1）手术及术中情况。（2）术后情况。（3）随访情况。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（Q1,Q3）或M（范围）表示。计数资料以绝对数或百分数表示。
    （1）手术及术中情况。32例患者均顺利完成腹腔镜HHR‑TEF‑DDSF。手术时间为（75±10）min,术中出血量为50（50,100）mL。32例患者中,无中转开腹,无输血,无意外大出血、邻近脏器损伤等术中并发症,无术中不良事件及死亡。（2）术后情况。32例患者术后首次肛门排气时间为1（1,2）d,术后首次排便时间为1（1,3）d,术后首次进食流质食物时间为1（1,3）d,术后引流管留置时间为3（3,6）d,术后住院时间为6（5,14）d,术后吞咽困难减轻时间为5（5,8）d,术后短期均未见明显呃逆。（3）随访情况。32例患者均获得术后随访,随访时间为7.5（3.0~11.0）个月。32例患者中,术后消化道总体症状、呼吸道总体症状主观缓解分别为26、32例；质子泵抑制剂停药率为84.4%（27/32）,疗效满意率为87.5%（28/32）；术后并发症腹胀、吞咽困难、腹泻、排气增多发生率分别为21.9%（7/32）、18.8%（6/32）、6.3%（2/32）、3.1%（1/32）,术后2个月内吞咽困难均明显缓解,至随访截止时间无患者存在持续性吞咽不畅；无死亡、症状复发和再手术患者。
    HHR‑TEF‑DDSF治疗胃食管反流病安全、可行,短期效果良好。

     

    Abstract:
    Objective To investigate the clinical efficacy of laparoscopic hiatal hernia repair with tunneled esophagogastric fundoplication and diaphragmatic dome suspension‑fixation (HHR-TEF-DDSF) in the treatment of gastroesophageal reflux disease.
    Methods The retrospective and descriptive study was conducted. The clinical data of 32 patients with gastroesophageal reflux disease who were admitted to Yifu Hospital Affiliated to Nanjing Medical University from October 2024 to June 2025 were collected. There were 20 males and 12 females, aged (68±7)years. All patients underwent laparoscopic HHR-TEF-DDSF. Observation indicators: (1) surgical and intraoperative conditions; (2) postoperative conditions; (3) follow‑up. Measurement data with normal distribution were expre-ssed as Mean±SD, while measurement data with skewed distribution were expressed as M(Q1,Q3) or M(range). Count data were expressed as absolute numbers or percentages.
    Results (1) Surgical and intraoperative conditions. All 32 patients successfully underwent laparoscopic HHR‑TEF‑DDSF. The operation time was (75±10)minutes, and volume of intraoperative blood loss was 50(50,100)mL. Among the 32 patients, there was no conversion to open surgery, no blood transfusion, no intra-operative complications such as unexpected massive hemorrhage or adjacent organ injury, no intra-operative adverse event or death. (2) Postoperative conditions. For the 32 patients, the time to post-operative first flatus was 1(1,2)days, the time to postoperative first defecation was 1(1,3)days, the time to postoperative first intake of liquid food was 1(1,3)days, the duration of postoperative drainage tube indwelling was 3(3,6)days, the postoperative hospital stay was 6(5,14)days, and the time to relief of postoperative dysphagia was 5(5,8)days. No obvious hiccup was observed in any patient in the short term after surgery. (3) Follow‑up. All 32 patients were followed up for 7.5(range, 3.0-11.0)months. Among the 32 patients, 26 cases achieved subjective relief of overall postoperative digestive tract symptoms, and 32 cases achieved subjective relief of overall postoperative respiratory tract symptoms. The proton pump inhibitor (PPI) withdrawal rate was 84.4%(27/32), and the treatment satisfaction rate was 87.5%(28/32). The incidences of postoperative complications inclu-ding abdominal distension, dysphagia, diarrhea, and increased flatus were 21.9%(7/32), 18.8%(6/32), 6.3%(2/32), and 3.1%(1/32), respectively. Dysphagia was significantly relieved in all affected patients within 2 months after surgery, and no patient had persistent dysphagia by the end of the follow‑up period. There was no death, symptom recurrence, or reoperation.
    Conclusion HHR‑TEF‑DDSF is safe and feasible in the treatment of gastroesophageal reflux disease, with favorable short‑term efficacy.

     

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