论文部分内容阅读
目的探讨腹腔镜下Nissen胃底折叠术(LNF)治疗老年食管裂孔疝的安全性及效果。方法回顾性分析2013年8月至2014年3月期间于徐州医学院附属医院普通外科接受LNF的35例老年食管裂孔疝患者的临床资料。结果 35例患者的手术均在腹腔镜下成功完成,无中转开腹。手术时间65~105 min,平均72 min;术中出血10~120 mL,平均30 mL;术后住院时间3~23 d,平均5 d。术后2例发生轻度食管反流,1例进流质饮食后出现呕吐,考虑食管裂孔缩小或包绕过紧,其余无严重并发症及死亡病例。术后33例获访,随访时间为6~12个月,平均8.5个月。至术后6个月,获访患者的反酸、烧心、胸痛、咳嗽、喘息、咽异物感及声音嘶哑的评分较术前均下降,差异具有统计学意义(P<0.05)。随访期间33例患者均未见有疝复发,无明显反流症状。结论 LNF对老年食管裂孔疝患者来说是一项安全有效的手术方式,能取得良好的临床效果。
Objective To investigate the safety and efficacy of laparoscopic Nissen fundoplication (LNF) in the treatment of senile hiatal hernia. Methods The clinical data of 35 elderly patients with esophageal hiatal hernia who received LNF in the general surgery department of Xuzhou Medical College Affiliated Hospital from August 2013 to March 2014 were retrospectively analyzed. Results All 35 patients underwent laparoscopic surgery without laparotomy. The operation time ranged from 65 to 105 minutes, with an average of 72 minutes. The intraoperative bleeding ranged from 10 to 120 mL with an average of 30 mL. The postoperative hospital stay was 3 to 23 days with an average of 5 days. Mild esophageal reflux occurred in 2 cases and vomiting occurred in 1 case after entering into the liquid diet. Considering the narrowing or wrapping of the esophageal hiatus, the other cases had no serious complication and death. 33 patients were followed up for 6 to 12 months with an average of 8.5 months. Six months after the operation, the scores of acid reflux, heartburn, chest pain, cough, wheezing, pharyngeal foreign body sensation and hoarseness in the interviewed patients were significantly lower than those before the operation (P <0.05). No recurrence of hernia was found in 33 patients during follow-up, and no obvious reflux symptoms were found. Conclusion LNF is a safe and effective surgical method for senile patients with hiatal hernia and can achieve good clinical results.