探讨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的临床疗效。

回顾性分析2012年1月至2016年1月，天津市第一中心医院普外科收治的胃食管反流病合并食管裂孔疝行腹腔镜食管裂孔疝修补联合胃底折叠术的54例患者临床资料，通过对其手术时间，术中出血量，术后住院天数及出现的术后并发症来评价腹腔镜食管裂孔疝修补联合胃底折叠术治疗效果。

53例(98%)患者行腹腔镜食管裂孔疝修补联合胃底折叠术治疗，1例(2%)因与脾脏粘连，分离困难，中转开腹；其中应用补片患者47例(87%)，未用补片7例(13%)；行Toupet、Nissen、Dor术的患者分别为32例(59.3%)、19例(35.2%)、3例(5.5%)；手术时间95～355 min，平均手术时间(193.6±87.6)min，术中出血量为10～600 ml，平均出血量(72.5±21.3)ml；53例患者术后住院天数3～18 d，1例患者术后62 d出院，平均(8.1±7.4)d，术后3 d拔除胃管；术后并发症中，消化道瘘1例(Nissen术)，经持续胃肠减压及腹腔引流10 d后好转，吞咽困难1例(Nissen术)，恶心、反流2例(Toupet术)，保守治疗1周后好转；随访3年，失访12例，余42例患者症状完全缓解。

对于胃食管反流病合并食管裂孔疝患者，腹腔镜疝修补联合胃底折叠术是一种安全、有效的治疗方法。

To explore the clinical efficacy of laparoscopic hiatal hernia repair in combination of fundoplication in treating patients with reflux esophagitis and hiatal hernia.

Retrospective analysis ofthe clinical data of 54 patients with reflux esophagitis and hiatal hernia under laparoscopic hiatal hernia repair in combination of fundoplication admitted from January 2012 to January 2016.In aspects of the operation time, intraoperative blood loss, postoperative hospitalization days and complications to evaluate the treatment effect of laparoscopic hiatal hernia repair combined fundoplication.

There were 53(98%)patients underwent the laparoscopic hiatal hernia repair and fundoplication.One case converted tolaparotomy.47(87%)patients used mesh repair while others did not.The number of patients who did the operation of Toupet, Nissen, Dor(gastric folding degree were 270°, 360°, 180°respectively)were 32(59.3%), 19(35.2%)and 3(5.5%). Operation time was 95~355 minutes, average time(193.6±87.6)minutes.Intra-operative blood loss was 10~600 ml, average blood loss(72.5±21.3)ml; the average postoperative hospitalization stay was(8.1±7.4)days, 53 patients′postoperative hospitalization stay were 3~18 days, one was 62 days.The extubation time was 3 days after operation.The complication included: One case with digestive fistula(Nissen), who recovered in 10 days after the continuous gastrointestinal decompression and peritoneal drainage.One case had the symptom of difficulty swallowing and 2 cases(Toupet)with sickness and reflux, with conservative treatment, they recovered in 1 week.In 3 years following up, 12 patients lost access and 42 patients had complete remission.

For reflux esophagitis and hiatal hernia patients, laparoscopic hiatal hernia repair and fundoplication is a safe and effective treatment method.