摘要
目的探讨腹腔镜下Toupet和Dor胃底折叠术治疗食管裂孔疝(HH)合并胃食管反流病(GERD)的临床疗效及其优缺点。方法回顾性分析2014年12月~2017年1月,新疆维吾尔自治区人民医院收治的127例食管裂孔疝(HH)合并胃食管反流病(GERD)患者的病案资料,比较两组患者术前及术后6个月24 h食管p H监测、食管测压、GERD Q量表评分数据及术中术后恢复情况等。结果 2组患者术后反流症状均明显改善(均P<0.05),但Dor组在减少反流次数和抑制长反流上均优于Toupet组,差异有统计学意义[反流次数:(14.36±10.58)次vs.(29.83±19.71)次,t=7.382,P=0.007;长反流次数:(0.64±0.21)次vs.(6.20±3.48)次,t=10.816,P=0.001]。2组术后食管下括约肌压力、残余压均明显升高,松弛率明显降低,Gerd Q量表评分明显降低,差异均有统计学意义(均P<0.05),Dor组在食管下括约肌压力(静息呼吸平均值)的恢复上优于Toupet组[(20.69±13.95)mm Hg vs.(12.91±6.89)mm Hg,t=4.586,P=0.031],但Toupet组术后无效吞咽较术前有所增加,且高于Dor组,差异有统计学意义[(9.15±6.44)%比(11.25±2.04)%,t=4.104,P=0.033]。2组手术时间、术中出血量、住院天数比较均无统计学意义(均P>0.05)。术后随访时间6~18个月(中位数12个月),Toupet组有1例(2.4%)复发,Dor组有1例(1.2%)复发,术后并发症比较差异无统计学意义(χ~2=4.362,P=0.359)。结论 2种胃底折叠术治疗HH合并GERD均安全、有效,但腹腔镜下Dor胃底折叠术在减少反流次数、抑制长反流、提高食管下括约肌压力(静息呼吸平均值)方面均优于Toupet胃底折叠术,但Toupet胃底折叠术较Dor胃底折叠术更易发生术后吞咽困难。
Objective To comparison the advantages and disadvantages of laparoscopic Toupet and Dor fundoplication in the treatment of hiatal hernia combined with gastroesophageal reflux disease.Methods Statistics Analysis 127 patients of GERD in our hospital from December 2014 to January 2017,41 underwent laparoscopic laparoscopic Toupet fundoplication（ Toupet Group）. 86 patients underwent laparoscopic laparoscopic Dor fundoplication（ Dor Group）. Comparing the Gerd Q rating scale scores,intraoperative and postoperative recovery and so on the between patients with esophageal reflux conditions,esophageal manometry in three groups. Results Two groups of patients were improved significantly compared with preoperative in reflux conditions（ P 0. 05）. Dor group was better than Toupet group in reducing thenumber of reflux episodes and suppressed the long-reflux,the difference was statistically significant[the number of reflux episodes：（ 14. 36 ± 10. 58） vs.（ 29. 83 ± 19. 71）,t = 7. 382,P = 0. 007,the long-reflux：（ 0. 64 ± 0. 21） vs.（ 6. 20 ± 3. 48）,t = 10. 816,P = 0. 001]. The postoperative esophageal sphincter pressure and residual pressure increased significantly,the rate of relaxation and Gerd Q Q scores reducted significantly compared with preoperative,the differences were statistically significant（ P 〈0. 05,for all）. Dor group was better than Toupet group in recovery lower esophageal sphincter pressure（ mean resting breathing） [（ 20. 69 ±13. 95） mm Hg vs.（ 12. 91 ± 6. 89） mm Hg,t = 4. 586,P = 0. 031]. But,the ineffective swallowing was increase in Toupet group compared with the preoperative,the difference was statistically significant [（ 9. 15 ±6. 44） % ：（ 11. 25 ± 2. 04） %,t = 4. 104,P = 0. 033]. There was no significant difference in operative time,blood loss,hospital stay and complications（ P 〈 0. 05）. We followed up these patients for 6 - 18 months（ median 12 months）. 6 - 18 months（ median 12 months）. There was no significant difference in recurrence[Toupet group： 1 case（ 2. 44%）,Dor group： 1 case（ 1. 12%）,χ2= 0. 292,P = 0. 589]. There was no significant difference in postoperative complications（ χ2= 4. 362,P = 0. 359）. Conclusion It was safe and feasible for this two fundoplications treating HH combined with GERD. But laparoscopic Dor fundoplication was better than Toupet fundoplication in reducing the number of reflux episodes and suppressed the longreflux and increase LES pressure（ mean resting respiration） and the incidence of postoperative dysphagia.
出处
《中华胃食管反流病电子杂志》
2017年第1期35-39,共5页
Chinese Journal Of Gastroesophageal Reflux Disease(Electronic Edition)
关键词
胃底折叠术
食管裂孔
胃食管反流病
Fundoplication
Esophageal foramnia
Gastroesophageal Reflux Disease
