单中心腹腔镜食管裂孔疝修补术经验。

Experience of laparoscopic paraesophageal hernia repair at a single institution.

机构信息

Section of Minimally Invasive Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA.

出版信息

Am J Surg. 2012 Jul;204(1):60-5. doi: 10.1016/j.amjsurg.2011.06.026. Epub 2011 Oct 11.

DOI:10.1016/j.amjsurg.2011.06.026

PMID:21992807

Abstract

BACKGROUND

Paraesophageal hernia patients are often elderly with complicating medical comorbidities, making surgical management complex in formulating a management strategy.

METHODS

Between January 2005 and July 2009, 93 patients underwent surgical treatment of paraesophageal hernia, including 8 recurrent cases after multiple repairs. Open transabdominal surgeries were performed in 14 (15%) patients, and combined thoracotomy was performed in 1 (1%). Laparoscopic surgeries were performed in 78 (84%) patients with 4 (5%) conversions. Artificial prosthetics were used in 27 (29%) patients. Fundoplication was performed in 82 (88%) patients. Gastropexy or feeding tube gastrostomy was performed in 10 (11%) patients.

RESULTS

The average length of the surgery was 125 minutes (range, 51-304 min). The mean blood loss was 100 mL. The average length of stay was 4 days (range, 1-14 d). There were 2 mortalities (2%) and 4 re-operations, with a recurrence rate of 2%.

CONCLUSIONS

Laparoscopic paraesophageal hernia repair can be performed safely with acceptable results when following a standard approach.

摘要

背景

食管裂孔疝患者通常为老年患者，合并多种复杂的医学合并症，这使得制定管理策略的手术管理变得复杂。

方法

在 2005 年 1 月至 2009 年 7 月期间，93 例食管裂孔疝患者接受了手术治疗，其中 8 例为多次修补术后复发。14 例（15%）患者行开腹经腹手术，1 例（1%）患者行联合开胸手术。78 例（84%）患者行腹腔镜手术，其中 4 例（5%）转为开腹手术。27 例（29%）患者使用人工假体。82 例（88%）患者行胃底折叠术。10 例（11%）患者行胃固定术或胃造口术。