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目的评价改良Nissen手术在滑动性食管裂孔疝治疗中的应用价值。方法回顾性分析自2001年6月至2013年5月蚌埠医学院第一附属医院52例滑动性食管裂孔疝经手术治疗患者的临床资料,其中男27例、女25例,平均年龄62.13(35~84)岁。所有患者术前均行上消化道X线钡餐造影、胃镜检查确诊为滑动性食管裂孔疝,均行改良Nissen手术,即胃底上提至贲门口上方2~3 cm,包绕双层缝合固定食管180°,并置于膈肌下方。分别于术后3个月、6个月、9个月在平卧头低位下行消化道X线钡餐检查,并长期随访,以评价手术效果。结果本组均顺利完成手术,无手术死亡,患者术前存在的食管下括约肌松弛和胃酸反流,术后均明显改善。术后平均住院时间9(5~11)d。52例患者术后2周内复查上消化道X线钡餐检查,无胃食管反流。所有患者均随访,随访时间2个月至10年。除1例术后半年并发食管狭窄外,其余患者均恢复顺利,症状消失,营养及发育好转。随访期间无复发。结论改良Nissen手术是治疗滑动性食管裂孔疝的有效方法,加强食管下段高压区,折叠胃及贲门口置于膈肌下方,不仅能使胃还纳腹腔,同时还有抗反流的效果。
Objective To evaluate the value of modified Nissen surgery in the treatment of sliding esophageal hiatal hernia. Methods The clinical data of 52 patients with sliding esophageal hiatal hernia treated in the First Affiliated Hospital of Bengbu Medical College from June 2001 to May 2013 were retrospectively analyzed. There were 27 males and 25 females with an average age of 62.13 (35 ~ 84) years old. All patients underwent upper gastrointestinal X-ray barium meal before surgery, endoscopic diagnosis of sliding esophageal hiatal hernia, were performed modified Nissen surgery, that is raised above the gastric fundus to the top 2 ~ 3 cm, surrounded by double suture Esophagus 180 °, and placed under the diaphragm. Respectively at 3 months, 6 months, 9 months after the low head down the lower gastrointestinal tract X-ray barium meal examination, and long-term follow-up to evaluate the effect of surgery. Results All the patients underwent successful surgery without any surgical death. The preoperative esophageal sphincter relaxation and gastric acid reflux showed significant improvement after operation. The average postoperative hospital stay 9 (5 ~ 11) d. Fifty-two patients underwent upper gastrointestinal X-ray barium meal examination within 2 weeks after operation without gastroesophageal reflux. All patients were followed up for 2 months to 10 years. Except for one case of esophageal stenosis in six months after operation, the rest of the patients recovered smoothly, the symptoms disappeared, and the nutrition and development improved. No recurrence during follow-up. Conclusion The modified Nissen operation is an effective method for the treatment of sliding esophageal hiatal hernia. By strengthening the high pressure area of the lower esophagus and folding the stomach and cardia under the diaphragm, it can not only make the stomach absorb the abdominal cavity but also have anti-reflux effect.