本文選題：胃食管反流病　切入點(diǎn)：食管裂孔疝　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的對(duì)比分析腹腔鏡下食管裂孔疝修補(bǔ)聯(lián)合Nissen、Toupet和Dor手術(shù)對(duì)食管裂孔疝合并胃食管反流病的手術(shù)效果,探討各自術(shù)式優(yōu)勢(shì)。方法收集鄭州大學(xué)第一附屬醫(yī)院惠濟(jì)院區(qū)及合作單位病例2013-2016年共計(jì)215例,所有患者手術(shù)方式包括腹腔鏡下食管裂孔疝修補(bǔ)術(shù),抗反流手術(shù)為三種方式,其中行Nissen手術(shù)治療60例,行Toupet手術(shù)治療83例,行Dor手術(shù)治療72例�；仡櫺苑治鋈M患者一般情況、手術(shù)時(shí)間、術(shù)后并發(fā)癥,以及患者術(shù)前、術(shù)后3月、術(shù)后6月的胃食管反流病癥狀評(píng)分(Gerd-Q評(píng)分表)、食管24小時(shí)Ph阻抗監(jiān)測(cè)、高分辨率食管壓力測(cè)定、電子胃鏡檢查結(jié)果。結(jié)果三組患者隨訪時(shí)間3~36個(gè)月,平均13個(gè)月。入組患者年齡、性別、BMI、反流癥狀病程、PPI藥物服用療程及平均住院天數(shù)均無(wú)統(tǒng)計(jì)學(xué)差異。食管裂孔疝修補(bǔ)術(shù)+Dor手術(shù)時(shí)長(zhǎng)明顯小于其他兩種手術(shù)方式,結(jié)果具有顯著性(P0.05)。三組術(shù)式并發(fā)癥比較,食管裂孔疝修補(bǔ)術(shù)+Nissen手術(shù)術(shù)后并發(fā)腹脹及吞咽困難幾率明顯高于其他兩種術(shù)式,結(jié)果有統(tǒng)計(jì)學(xué)差異(P=0.005,P=0.004)。分析指標(biāo)標(biāo)準(zhǔn)對(duì)比:三組患者均于術(shù)后3月隨訪GERD-Q表,術(shù)后6月復(fù)查食管24小時(shí)Ph阻抗監(jiān)測(cè)、高分辨率食管壓力測(cè)定、電子胃鏡。三組患者GERD-Q術(shù)后3個(gè)月與術(shù)前相比,均明顯降低(P0.05),三種手術(shù)之間手術(shù)效果無(wú)差異(P=0.149)。三組患者術(shù)后6個(gè)月復(fù)查食管測(cè)壓、食管測(cè)酸及胃鏡結(jié)果均較術(shù)前有明顯改善,(P0.05),且三種手術(shù)方式之間無(wú)明顯差異(P0.05)。結(jié)論腹腔鏡下食管裂孔疝修補(bǔ)術(shù)加抗反流手術(shù),包括Nissen、Toupet、Dor胃底折疊術(shù)均為治療HH合并GERD的有效、創(chuàng)傷小、恢復(fù)快的手術(shù)方式。三種手術(shù)方式均可以達(dá)到控制反流相關(guān)癥狀的效果,Dor以其手術(shù)時(shí)間短,術(shù)中出血少,不改變?cè)薪馄式Y(jié)構(gòu),便于臨床操作,值得臨床推廣。
[Abstract]:Objective to compare and analyze the effect of laparoscopic repair of hiatal hernia combined with nissenn Toupet and Dor in the treatment of hiatal hernia with gastroesophageal reflux disease (GERD).Methods A total of 215 patients in Huiji Hospital and cooperating Unit of the first affiliated Hospital of Zhengzhou University were collected from 2013 to 2016. All the patients underwent laparoscopic repair of esophageal hiatal hernia and three ways of anti-reflux surgery. Among them, 60 cases were treated with Nissen operation.83 cases were treated with Toupet and 72 cases with Dor.The general condition, operation time, postoperative complications, and the symptom scores of gastroesophageal reflux were analyzed retrospectively in the three groups. The symptom scores of gastroesophageal reflux were evaluated by Gerd-Q scale and 24 hour Ph impedance monitoring before operation, 3 months after operation and 6 months after operation.High resolution esophageal pressure measurement and electronic gastroscopy.Results the follow-up time was 3 ~ 36 months (mean 13 months).There was no significant difference in age, sex, duration of reflux and PPI course of treatment and average hospitalization days.The length of Dor in repair of esophageal hiatal hernia was significantly longer than that of the other two methods, and the result was significant (P 0.05).The incidence of abdominal distension and dysphagia after Nissen operation was significantly higher than that of the other two groups. The results showed that there was a significant difference between the two groups in the incidence of abdominal distension and dysphagia.Three groups of patients were followed up with GERD-Q table at 3 months after operation, and 24 hours Ph impedance monitoring, high resolution esophageal pressure measurement and electronic gastroscopy were reexamined 6 months after operation.Three months after GERD-Q, all the patients in the three groups were significantly lower than those before operation (P 0.05), and there was no difference in the results of the three kinds of operations (P < 0. 149).Six months after operation, esophageal manometry was reexamined in the three groups. The results of esophageal acid and gastroscopy were significantly improved compared with those before operation (P 0.05), and there was no significant difference among the three kinds of operation methods (P 0.05).Conclusion Laparoscopic repair of esophageal hiatal hernia combined with anti-reflux surgery, including Nissentor Toupetor fundus folding, is an effective method for the treatment of HH with GERD.All the three kinds of operation methods can control the symptoms of reflux. Dor is worth popularizing because of its short operation time, less bleeding during operation, no change of the original anatomical structure, and convenient for clinical operation.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R655.4
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本文編號(hào)：1687161