腹腔镜修复大型食管旁裂孔疝：生活质量与耐久性
Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability.
作者信息
Parameswaran R, Ali A, Velmurugan S, Adjepong S E, Sigurdsson A
机构信息
Shropshire Upper Gastrointestinal and Laparoscopic Surgery Unit, The Princess Royal Hospital, Apley Castle, Telford, Shropshire, United Kingdom, TF1 6TF.
出版信息
Surg Endosc. 2006 Aug;20(8):1221-4. doi: 10.1007/s00464-005-0691-7. Epub 2006 Jul 24.
BACKGROUND
Laparoscopic repair of large paraesophageal hiatus hernias (LPOHH) is shown to be a safe and effective operation in the short term. However, its long-term durability and its effect on quality of life are less well established. This study aimed to assess the midterm outcome for laparoscopic repair of LPOHH with validated quality-of-life symptom scores and barium studies.
METHODS
Between January 2000 and July 2004, 49 patients (27 women) with LPOHH underwent laparoscopic repair. The median age of these patients was 68 years (range, 38-90 years). The laparoscopic repair included resection of the hernia sac, reduction of its contents, esophageal mobilization up to the aortic arch, crural repair with sutures (mesh reinforcement in 17 cases), Nissen fundoplication, and fixation of the wrap to the crura. Follow-up assessment was prospective with quality-of-life questionnaires, the Gastrointestinal Symptom Rating Scale (GSRS), the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) scale, and barium studies.
RESULTS
The presenting symptoms were pain for 21 patients, reflux for 27 patients, bleeding or anemia for 14 patients, and dysphagia for 17 patients. Five emergency operations were performed. Short esophagus was present in 24 patients. There were two conversions to open surgery. The major morbidity (atrial fibrillation, pulmonary embolism, and splenectomy) rate was 10.2%, and the minor morbidity (chest infection, jaundice, dysphagia, small pneumothorax) rate was 20.4%. Six patients were deceased of unrelated causes at the time of follow-up evaluation. Responses to the questionnaires were obtained in 31 cases (75%). Using the Wilcoxon signed rank test, the results from the questionnaires showed a statistically significant improvement (p < 0.001) in abdominal pain, reflux, and indigestion scores (GSRS) and GERD-HRQOL scores. Follow-up barium studies for 27 patients (66%) showed recurrence in 4 patients (14.8%), 2 of which were symptomatic.
CONCLUSION
Laparoscopic repair of LPOHH is associated with good quality of life as well as an acceptable midterm recurrence rate.
背景
腹腔镜修复大型食管旁裂孔疝（LPOHH）在短期内已被证明是一种安全有效的手术。然而，其长期耐久性及其对生活质量的影响尚不明确。本研究旨在通过验证的生活质量症状评分和钡餐检查来评估腹腔镜修复LPOHH的中期结果。
方法
2000年1月至2004年7月期间，49例LPOHH患者（27例女性）接受了腹腔镜修复手术。这些患者的中位年龄为68岁（范围38 - 90岁）。腹腔镜修复包括疝囊切除、内容物回纳、食管游离至主动脉弓、缝合修复膈肌脚（17例使用补片加强）、Nissen胃底折叠术以及将胃底折叠固定于膈肌脚。通过生活质量问卷、胃肠道症状评分量表（GSRS）、胃食管反流病健康相关生活质量（GERD - HRQOL）量表和钡餐检查进行前瞻性随访评估。
结果
主要症状为21例患者有疼痛，27例患者有反流，14例患者有出血或贫血，17例患者有吞咽困难。进行了5例急诊手术。24例患者存在短食管。有2例转为开放手术。主要并发症（心房颤动、肺栓塞和脾切除术）发生率为10.2%，次要并发症（胸部感染、黄疸、吞咽困难、小气胸）发生率为20.4%。6例患者在随访评估时因无关原因死亡。31例（75%）患者完成了问卷回复。使用Wilcoxon符号秩检验，问卷结果显示腹痛、反流和消化不良评分（GSRS）以及GERD - HRQOL评分有统计学显著改善（p < 0.001）。27例（66%）患者的随访钡餐检查显示4例（14.8%）复发，其中2例有症状。
结论
腹腔镜修复LPOHH与良好的生活质量以及可接受的中期复发率相关。
Zotero 插件