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

doi:10.3877/cma.j.issn.2095-8765.2019.01.009

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

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

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

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