經腹食管裂孔修補加Dor胃底折疊術治療食管裂孔疝的遠期療效觀察
發(fā)布時間：2018-10-05 07:29
【摘要】：目的：探討經腹行食管裂孔修補加Dor部分胃底折疊術治療食管裂孔疝的遠期療效。 方法：對2007年10月至2011年9月天津市胸科醫(yī)院胸外科41例食管裂孔疝患者行食管裂孔疝修補術及Dor胃底折疊術的資料進行統(tǒng)計分析。其中男性8例,女性33例。年齡34～81歲,30～50歲患者2例,50-70歲患者19例,70歲以上患者20例,平均年齡67歲。入院前病人均有不同程度的返酸,主要表現為返酸燒心者28例,表現為上腹疼痛不適者8例,表現為惡心嘔吐者5例。病史3個月-30年。術前、術后短期、術后遠期分別對患者進行綜合評估,記錄手術時間、術中出血量、術后住院時間、術后癥狀緩解情況,手術前后胃鏡、食管測壓、食管24小時pH測定,上消化道造影情況,術后生活質量評分及術后并發(fā)癥情況。記錄術前、術后3個月、術后1年的隨訪情況。通過自身配對t檢驗方法對配對指標進行統(tǒng)計學分析,觀察經腹食管裂孔修補及Dor胃底折疊術治療食管裂孔疝的遠期療效。 結果：41例患者均手術順利,手術時間60-180min,平均85miin;術中出血量20-80mL,平均35mL；術后住院時間7-30d,平均12d。術后燒心返酸等癥狀均明顯緩解,無圍手術期死亡病例。41例均得到隨訪,隨訪時間為1年至5年,平均3.4年,無術后復發(fā)病例。手術結果滿意率95.12%。1例患者術后切口感染,經換藥處理后痊愈。4例患者術后短期內進固體食物時有不同程度哽噎感,3例可耐受,1例患者行球囊擴張后好轉,遠期隨訪仍有2例述進固體食物時輕度哽咽感,但均可耐受。食管測酸測壓結果顯示經手術治療后患者食管下端括約肌壓力增加,有效地建立食管下段抗返流屏障抑制酸反流。伴有返流性食管炎的患者術前均有不同程度的食管炎癥,術后復查胃鏡,其食管粘膜隨著時間的延長逐漸恢復,1年后復查全部恢復正常。對比術前與術后生活質量評分、食管測酸及測壓結果,術后遠期和術前比較,差異有統(tǒng)計學意義(P均0.05)；術后遠期和術后短期比較差異無統(tǒng)計學意義(P均0.05)。 結論：隨著造影、內鏡等檢查技術的應用以及人們對疾病認識水平的提高,食管裂孔疝這一歐美常見疾病在我國的檢出率正在逐年增加。腹腔鏡技術在我國發(fā)展較快,很多家三甲醫(yī)院均能進行此類手術,但仍處于探索階段,較國外仍存在一定差距,且受醫(yī)院本身硬件條件限制,部分醫(yī)院無腹腔鏡相關技術及設備。因此,經腹行食管裂孔修補加Dor胃底折疊術是一種較實用的選擇,而且具有出血少,對患者心肺功能影響小,療效確切,費用低等特點,具有臨床推廣價值。由于臨床資料有限,只隨訪到術后5年內療效,更遠期療效還需繼續(xù)隨訪觀察。
[Abstract]:Objective: to investigate the long-term effect of transabdominal repair of esophageal hiatus and Dor partial fundus folding in the treatment of hiatal hernia. Methods: the data of 41 cases of esophageal hiatal hernia repair and Dor fundus folding in thoracic surgery of Tianjin chest Hospital from October 2007 to September 2011 were analyzed statistically. There were 8 males and 33 females. Two patients aged from 50 to 50 years old, 19 patients over 70 years old and 20 patients over 70 years old, with an average age of 67 years. All the patients had different degrees of regurgitation before admission. The main manifestations were acid burning in 28 cases, upper abdominal pain and discomfort in 8 cases, nausea and vomiting in 5 cases. History 3 months-30 years. The patients were evaluated before and after operation, the time of operation, the amount of blood lost during operation, the time of hospitalization after operation, the relief of symptoms after operation, gastroscopy, esophageal manometry and 24 hour esophageal pH were recorded before and after operation. Upper gastrointestinal angiography, postoperative quality of life score and postoperative complications. The follow-up data were recorded before operation, 3 months after operation and 1 year after operation. The long-term efficacy of transabdominal esophageal hiatus repair and Dor fundus folding in the treatment of esophageal hiatal hernia was observed. Results all 41 cases were successfully operated, the operative time was 60-180 min (average 85miin), the amount of intraoperative bleeding was 20-80 mL (mean 35 mL), and the postoperative hospitalization time was 7-30 days (mean 12 days). All patients were followed up for 1 to 5 years with an average of 3.4 years. The satisfactory rate of operation was 95.12.1 cases of incision infection after operation. After dressing change, 4 cases were cured, 4 cases had different degree of choking and feeling of choking during the short period of time after operation, 3 cases could tolerate it, and 1 case had improved after balloon dilatation. At long-term follow-up, 2 patients with mild choking in solid food were tolerable. The results of esophageal acid manometry showed that the lower esophageal sphincter pressure increased after surgical treatment, which effectively established the lower esophageal anti-reflux barrier to inhibit acid reflux. The patients with reflux esophagitis had different degree of esophagitis before operation. After operation, the esophagus mucosa gradually recovered with the extension of time, and all of them returned to normal after one year. Compared with preoperative and postoperative quality of life scores, esophageal acid and pressure test results, postoperative long-term and preoperative differences were statistically significant (P 0.05), postoperative long-term and postoperative short-term differences were not statistically significant (P 0.05). Conclusion: with the application of radiography, endoscopic examination and the improvement of people's understanding of the disease, the detection rate of esophageal hiatal hernia, a common disease in Europe and America, is increasing year by year in China. The technique of laparoscopy is developing rapidly in our country. Many third Class A hospitals can perform this kind of operation, but it is still in the exploratory stage, and there is still a certain gap compared with foreign countries, and it is limited by the hardware condition of the hospital itself. Some hospitals do not have laparoscopy related technology and equipment. Therefore, transabdominal repair of esophageal fissure and Dor fundus folding is a practical choice with less bleeding, less influence on cardiopulmonary function, accurate curative effect and low cost. Due to limited clinical data, only 5 years after the follow-up, more long-term results need to continue to follow-up observation.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R655.4
本文編號：2252527
[Abstract]:Objective: to investigate the long-term effect of transabdominal repair of esophageal hiatus and Dor partial fundus folding in the treatment of hiatal hernia. Methods: the data of 41 cases of esophageal hiatal hernia repair and Dor fundus folding in thoracic surgery of Tianjin chest Hospital from October 2007 to September 2011 were analyzed statistically. There were 8 males and 33 females. Two patients aged from 50 to 50 years old, 19 patients over 70 years old and 20 patients over 70 years old, with an average age of 67 years. All the patients had different degrees of regurgitation before admission. The main manifestations were acid burning in 28 cases, upper abdominal pain and discomfort in 8 cases, nausea and vomiting in 5 cases. History 3 months-30 years. The patients were evaluated before and after operation, the time of operation, the amount of blood lost during operation, the time of hospitalization after operation, the relief of symptoms after operation, gastroscopy, esophageal manometry and 24 hour esophageal pH were recorded before and after operation. Upper gastrointestinal angiography, postoperative quality of life score and postoperative complications. The follow-up data were recorded before operation, 3 months after operation and 1 year after operation. The long-term efficacy of transabdominal esophageal hiatus repair and Dor fundus folding in the treatment of esophageal hiatal hernia was observed. Results all 41 cases were successfully operated, the operative time was 60-180 min (average 85miin), the amount of intraoperative bleeding was 20-80 mL (mean 35 mL), and the postoperative hospitalization time was 7-30 days (mean 12 days). All patients were followed up for 1 to 5 years with an average of 3.4 years. The satisfactory rate of operation was 95.12.1 cases of incision infection after operation. After dressing change, 4 cases were cured, 4 cases had different degree of choking and feeling of choking during the short period of time after operation, 3 cases could tolerate it, and 1 case had improved after balloon dilatation. At long-term follow-up, 2 patients with mild choking in solid food were tolerable. The results of esophageal acid manometry showed that the lower esophageal sphincter pressure increased after surgical treatment, which effectively established the lower esophageal anti-reflux barrier to inhibit acid reflux. The patients with reflux esophagitis had different degree of esophagitis before operation. After operation, the esophagus mucosa gradually recovered with the extension of time, and all of them returned to normal after one year. Compared with preoperative and postoperative quality of life scores, esophageal acid and pressure test results, postoperative long-term and preoperative differences were statistically significant (P 0.05), postoperative long-term and postoperative short-term differences were not statistically significant (P 0.05). Conclusion: with the application of radiography, endoscopic examination and the improvement of people's understanding of the disease, the detection rate of esophageal hiatal hernia, a common disease in Europe and America, is increasing year by year in China. The technique of laparoscopy is developing rapidly in our country. Many third Class A hospitals can perform this kind of operation, but it is still in the exploratory stage, and there is still a certain gap compared with foreign countries, and it is limited by the hardware condition of the hospital itself. Some hospitals do not have laparoscopy related technology and equipment. Therefore, transabdominal repair of esophageal fissure and Dor fundus folding is a practical choice with less bleeding, less influence on cardiopulmonary function, accurate curative effect and low cost. Due to limited clinical data, only 5 years after the follow-up, more long-term results need to continue to follow-up observation.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R655.4
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