评估在食管裂孔疝修补术与胃底折叠术中应用“四位一体”理念的疗效。

回顾性分析2021年1月至2022年1月中山大学附属第六医院进行的食管裂孔疝修补术+胃底折叠术的82例患者资料和手术录像。其中，40例患者采用腹腔镜改良Nissen法进行胃底折叠及“四位一体”技术处理食管胃连接部（研究组），42例患者仅采用腹腔镜改良Nissen法进行胃底折叠（对照组）。分析人口统计学、围手术期和生活质量结果数据。

相较于研究组，对照组在手术时间和出血量方面表现出较优越趋势[(151.86±38.44) min 比 (171.82±38.07) min，P=0.021；（94.50±49.61）ml 比（113.81±56.35）ml，P=0.104]。研究组中有8例患者（20%）发生了术后吞咽困难，较对照组的5例（11.9%）发生率略高。然而术后半年，研究组的Likert预后评分显著优于对照组（P=0.028）。研究组中67.5%的患者在过去半年内自我评价无症状（1级），明显高于对照组的40.5%。此外，在症状无改善/复发/恶化的患者中（定义为4级和5级），对照组有6例和2例，而研究组无患者报告这两个级别的情况。

采用“四位一体”理念处理食管胃连接部可提高患者术后满意率和生活质量，但伴随手术时间和出血风险的增加。本研究的结论尚待前瞻性实验验证。

To evaluate the therapeutic efficacy of applying the "Four-in-One" concept in the repair of hiatal hernia and fundoplication surgery.

A retrospective analysis was conducted on the data and surgical videos of 82 patients who underwent hiatal hernia repair and fundoplication surgery at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2021 to January 2022. Among them, 40 patients underwent fundoplication using laparoscopic modified Nissen fundoplication combined with the "Four-in-One" technique for the treatment of the esophagogastric junction (study group), while 42 patients underwent laparoscopic modified Nissen fundoplication alone (control group). Demographic, perioperative, and quality of life outcome data were analyzed.

Compared to the study group, the control group exhibited a superior trend in terms of operative time and blood loss [(151.86±38.44) minutes vs (171.82±38.07) minutes, P=0.021; (94.50±49.61) ml vs (113.81±56.35) ml, P=0.104]. In the study group, 8 patients (20%) experienced postoperative dysphagia, slightly higher than the 5 cases (11.9%) in the control group. However, at six months postoperatively, the study group demonstrated significantly better Likert prognosis scores compared to the control group (Fisher's exact test, P=0.028). Moreover, 67.5% of the study group's patients self-assessed as asymptomatic (Grade 1) in the past six months, which was significantly higher than the 40.5% in the control group. Additionally, among patients defined as having no improvement/recurrence/deterioration of symptoms (defined as Grades 4 and 5), the control group had 6 cases and 2 cases, while the study group had no patients reporting these two levels of severity.

The application of the "Four-in-One" concept in the treatment of the esophagogastric junction can improve postoperative satisfaction and quality of life for patients, albeit with increased operative time and bleeding risk. Prospective experiments are needed to validate the conclusions of this study.