超越贝尔西手术：复杂的腹腔镜食管裂孔和膈疝修补术
Beyond Belsey: complex laparoscopic hiatus and diaphragmatic hernia repair.
作者信息
Zanotti D, Fiorani C, Botha A
机构信息
Upper Gastrointestinal Surgical Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK , London , UK.
出版信息
Ann R Coll Surg Engl. 2019 Mar;101(3):162-167. doi: 10.1308/rcsann.2018.0183. Epub 2018 Oct 16.
BACKGROUND
Diaphragmatic and hiatus hernias can cause mild chronic symptoms or have an acute presentation with gastric volvulus and obstruction. Elective or emergency surgery is indicated in symptomatic patients and nowadays is generally performed laparoscopically.
METHODS
We report four different types of hernias: a giant hiatus hernia following a gastric pull-up for recurrent congenital diaphragmatic hernia; a Bochdalek hernia in a pregnant young woman; concomitant hiatus and Morgagni hernias; and a giant hiatus hernia occupying the right chest. All were approached laparoscopically, either electively or as an emergency.
RESULTS
Surgery led to a resolution of symptoms in all the cases. We had no any intraoperative complications. Two patients developed minor postoperative complications (chest infection). No recurrences were found during a mean follow-up of 18 months.
CONCLUSIONS
Transabdominal laparoscopic approach is a safe and feasible approach to all cases of symptomatic hiatus and diaphragmatic hernia.
背景
膈疝和食管裂孔疝可引起轻度慢性症状，或急性表现为胃扭转和梗阻。有症状的患者需行择期或急诊手术，目前一般通过腹腔镜进行。
方法
我们报告了四种不同类型的疝：复发性先天性膈疝行胃上提术后的巨大食管裂孔疝；一名年轻孕妇的博赫dalek疝；同时存在的食管裂孔疝和莫尔加尼疝；以及占据右胸的巨大食管裂孔疝。所有病例均通过腹腔镜进行处理，包括择期手术或急诊手术。
结果
手术使所有病例的症状均得到缓解。我们没有任何术中并发症。两名患者出现了轻微的术后并发症（肺部感染）。在平均18个月的随访中未发现复发。
结论
经腹腹腔镜手术是治疗所有有症状的食管裂孔疝和膈疝病例的一种安全可行的方法。
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