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中华胃食管反流病电子杂志

中华胃食管反流病电子杂志 ›› 2019, Vol. 06 ›› Issue (01) : 29 -33. doi: 10.3877/cma.j.issn.2095-8765.2019.01.009

所属专题： 文献；

论著

儿童开腹与腹腔镜食管裂孔疝修补＋胃底折叠术的疗效比较
玉苏甫·阿克木1, 阿孜古丽1, 和军1, 刘东1, 阿布都塞米1, 李水学1,†()   
  1. 1. 830000　乌鲁木齐，新疆维吾尔自治区人民医院小儿外科
  • 收稿日期:2018-09-28 出版日期:2019-02-15
  • 通信作者: 李水学

A single-center clinical comparison of hiatal hernia in pediatric patients: laparoscopic versus open approaches

Akemu Yusufu1, Aziguli1, Jun He1, Dong Liu1, Abudousaimi1, Shuixue Li1,†()   

  1. 1. Department of Pediatric Surgery, The Xinjiang Uygur Autonomous Region People's Hospita, Urumi 830000, China
  • Received:2018-09-28 Published:2019-02-15
  • Corresponding author: Shuixue Li
  • About author:
    Corresponding author: Li Shuixue, Email:
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玉苏甫·阿克木, 阿孜古丽, 和军, 刘东, 阿布都塞米, 李水学. 儿童开腹与腹腔镜食管裂孔疝修补＋胃底折叠术的疗效比较[J]. 中华胃食管反流病电子杂志, 2019, 06(01): 29-33.

Akemu Yusufu, Aziguli, Jun He, Dong Liu, Abudousaimi, Shuixue Li. A single-center clinical comparison of hiatal hernia in pediatric patients: laparoscopic versus open approaches[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2019, 06(01): 29-33.

目的

比较儿童开腹与腹腔镜食管裂孔疝（HH）修补+胃底折叠术的疗效及安全性。

方法

回顾性分析2008年1月至2018年1月新疆维吾尔自治区人民医院收治的经上消化道造影检查诊断为HH的42例患儿。其中20例行开腹HH修补＋胃底折叠术（开腹手术组），22例行腹腔镜HH修补＋胃底折叠术（腹腔镜手术组）。记录并比较2组患儿的切口长度、手术时间、术中出血量、术后进食时间、术后住院时间，同时观察2组患儿术后疼痛及并发症发生情况，并比较2组患儿术后并发症发生率。

结果

腹腔镜手术组患儿切口长度短于开腹手术组患儿［（2.2±0.3）cm vs （7.5±1.1）cm］，且差异有统计学意义（t=20.833，P<0.05）；但2组患儿手术时间、术中出血量差异均无统计学意义［（115.4± 20.5）min vs （104.2±18.6）min，（2.9±0.3）ml vs （3.1±0.5）ml，t=1.552、1.857，P均>0.05］。腹腔镜手术组患儿术后进食时间、术后住院时间均短于开腹手术组患儿［（1.3±0.3）d vs （2.2±0.4）d，（5.2±1.6）d vs （9.3±1.1）d］，且差异均有统计学意义（t=8.182、9.753，P均<0.05）。2组患儿术后并发症发生率差异无统计学意义［9.1% （2/22）vs 5.0% （1/20），χ2=0.264，P>0.05］。开腹与腹腔镜HH修补＋胃底折叠术均为小儿HH安全、有效的治疗方法。与开腹手术比较，腹腔镜手术术后禁食时间短，术后恢复快，更美观。

关键词: 疝，食管裂孔, 胃底折叠术, 腹腔镜
Objective

To evaluate the efficacy and safety of open and laparoscopic procedure for hiatal hernia repair with fundoplication in pediatric patients.

Methods

From January 2008 to January 2018, 42 cases of children with hiatal hernia were treated with open and laparoscopic repair of esophageal hiatal hernia with fundoplication. The clinical data were retrospectively analyzed and compared. The data included: operative time, intraoperative bleeding, postoperative pain, postoperative feeding time, postoperative hospital stay, length of incision, and incidence of postoperative complications.

Results

Chief complaints of patients include vomiting, acid reflux, repeated respiratory infections, refractory anemia, malnutrition, and physical examination findings. Among them, 20 underwent open surgery and 22 underwent laparoscopic surgery. There was no differences on gender, age, and weight between the two groups. Ages from 6month to 14 years old. One laparoscopic operation was converted to open procedure. All operations were successfully completed. Each group had one postoperative recurrence. Laparoscopic surgery group significantly better than the open surgery group on postoperative eating time, postoperative hospital stay, incision length, the difference was statistically significant (P<0.05), there was no significant difference in the operation time, intraoperative bleeding, postoperative pain, postoperative complications between the two groups (P>0.05).

Conclusions

Open and laparoscopic repair with fundoplication of hiatal hernia are all safe and effective treatment methods for pediatric patients. Compared with open surgery, laparoscopic surgery has the advantages of short postoperative fasting time, rapid postoperative recovery, and beautiful appearance.

Key words: Hernia, hiatal, Fundoplication, Laparoscopy
表1 两组病例的一般情况
组别 例数 平均年龄（岁） 性别（例，男性/女性） 体质量（kg，±s）
腹腔镜手术组 22 4.2±3.0 13/9 17.3±4.3
开腹手术组 20 4.0±2.8 11/9 17.1±4.5
检验值 ? t=0.223 χ2=0.07 t=0.147
P值 ? >0.05 >0.05 >0.05
表2 2组患儿手术情况比较（±s）
组别 例数 切口长度（cm） 手术时间（min） 术中出血量（ml）
腹腔镜手术组 22 2.2±0.3 115.4±20.5 2.9±0.3
开腹手术组 20 7.5±1.1 104.2±18.6 3.1±0.5
t值 ? 20.833 1.857 1.552
P值 ? <0.05 >0.05 >0.05
表3 2组患儿术后情况比较（±s）
组别 例数 术后进食时间（d） 术后住院时间（d） 术后并发症发生率［%（例/例）］
腹腔镜手术组 22 1.3±0.3 5.2±1.6 9.1%（2/22）
开腹手术组 20 2.2±0.4 9.3±1.1 5.0%（1/20）
检验值 ? t=8.182 t=9.753 χ2=0.264
P值 ? <0.05 <0.05 >0.05
1
Rivière P, Zerbib F. Gastroesophageal reflux in infants, children and adults. Hiatal hernia [J]. Rev Prat, 2017, 67(8): e367-e374.
2
Amano H, Tanaka Y, Kawashima H, et al. Mesh hiatal reinforcement in laparoscopic Nissen fundoplication for neurologically impaired children is safe and feasible [J]. Nagoya J Med Sci, 2017, 79(4): 427-433.
3
Hassan A, Alabdrabalmeer M, Alealiwi M, et al. Incidental Morgagni hernia found during laparoscopic repair of hiatal hernia: Case report & review of literature [J]. Int J Surg Case Rep, 2019, 57: 97-101.
4
Weyhe D, Uslar V, Kühne J, et al. [Hiatus hernia: Standards and controversies in diagnostics and treatment] [J]. Chirurg, 2019, 90(4): 331-348.
5
Dallemagne B, Weerts JM, Jehaes C, et al. Laparoscopic Nissen fundoplication: preliminary report [J]. Surg Laparosc Endosc, 1991, 1(3): 138-143.
6
Weitzendorfer M, Pfandner R, Antoniou SA, et al. Short-term results after laparoscopic repair of giant hiatal hernias with pledgeted sutures: a retrospective analysis [J]. Hernia, 2019, 23(2): 397-401.
7
Chevrollier GS, Brown AM, Keith SW, et al. Preoperative anemia: a common finding that predicts worse outcomes in patients undergoing primary hiatal hernia repair [J]. Surg Endosc, 2019, 33(2): 535-542.
8
和军，周玲，玉苏甫•阿克木，等．小儿食管裂孔疝腹腔镜手术治疗效果分析[J/CD]．中华胃食管反流病电子杂志, 2014, 4(1): 23-26.
9
刘文英．儿童胸外科的发展与现状[J]．中华小儿外科杂志, 2015, 36(8): 566-569.
10
Seo HS, Choi M, Son SY, et al. Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux Disease 2018 [J]. J Gastric Cancer, 2018, 18(4): 313-327.
11
Lundell L, Bell M, Ruth M. Systematic review: laparoscopic fundoplication for gastroesophageal reflux disease in partial responders to proton pump inhibitors [J]. World J Gastroenterol, 2014, 20(3): 804-813.
12
Rochefort M, Wee JO. Management of the Difficult Hiatal Hernia [J]. Thorac Surg Clin, 2018, 28(4): 533-539.
13
Yu HX, Han CS, Xue JR, et al. Esophageal hiatal hernia: risk, diagnosis and management [J]. Expert Rev Gastroenterol Hepatol, 2018. 12(4): 319-329.
14
Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition [J]. J Pediatr Gastroenterol Nutr, 2018, 66(3): 516-554.
15
张成，克力木，汪忠镐，等．食管裂孔疝胃底折叠方式选择及评价[J]．腹腔镜外科杂志, 2016, 21(2): 88-91.
16
Varjú P, Horváth ÖP, Papp A, et al. [Effectivity of the Nissen fundoplication and the influencing factors of the success. Results at the Medical Centre of Pecs depending on the indications and symptoms] [J]. Orv Hetil, 2018, 159(25): 1013-1023.
17
Garvey EM, Ostlie DJ. Hiatal and paraesophageal hernia repair in pediatric patients [J]. Semin Pediatr Surg, 2017, 26(2): 61-66.
18
Zhang C, Hu ZW, Yan C, et al. Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on pH-monitoring and symptom-scale [J]. World J Gastroenterol, 2017, 23(19): 3546-3555.
19
刘皎然．新生儿食道裂孔疝超声表现1例[J]．临床超声医学杂志, 2013, 15(1): 44.
20
Banki F. Short esophagus is a disease of the past and the prevention of recurrent hiatal hernia is the challenge of the future. J Thorac Cardiovasc Surg, 2018, 155(3): 1345-1347.
21
克力木，张成，牛伟亚，等．腹腔镜食管裂孔疝修补术并发症的预防[J/CD]．中华疝和腹壁外科杂志（电子版), 2011, 5(2): 149-151.
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