目的 探讨腹腔镜下行食管裂孔疝修补联合胃底折叠术对食管裂孔疝合并胃食管反流患者的临床疗效及并发症的影响.方法 选择2012年1月至2015年1月华北理工大学附属医院收治的食管裂孔疝合并胃食管反流患者72例,按照随机数字表法分为观察组和对照组,各36例.对照组行常规开腹手术,观察组于腹腔镜下行食管裂孔疝修补联合胃底折叠术.比较2组患者的手术时间、术中出血量、胃肠道功能恢复时间、术后住院时间、治疗前后的反流性疾病问卷(RDQ)各症状评分和消化病生存质量指数(GLQI)评分以及术后并发症发生情况.结果 观察组的手术时间、术中出血量、胃肠道功能恢复时间及术后住院时间均明显少于对照组[(76±10) min比(95±12) min、(28±10)ml比(77±21)ml、(1.2±0.4)d比(3.6±1.0)d、(6.1±1.6)d比(11.9±2.4)d],差异均有统计学意义(均P＜0.05).观察组与对照组患者治疗前RDQ各症状评分[胸痛:(4.73±2.31)分比(4.82±2.53)分,烧心:(6.13±2.43)分比(6.02±1.93)分,反酸:(4.29±2.12)分比(4.36±2.31)分,反食:(5.02±2.17)分比(5.13±2.62)分]和GLQI评分比较[自觉症状:(48.4±9.1)分比(49.0±8.9)分,生理功能状态:(15.3±5.1)分比(15.4±5.3)分,精神、心理状态:(12.3±4.2)分比(12.1±3.6)分,生活、社会状态:(8.9±2.5)分比(8.7±2.6)分,总评分:(84.5±12.5)分比(84.8±12.8)分],差异均无统计学意义(均P＞0.05).治疗后,2组患者RDQ各症状评分均明显低于治疗前,GLQI评分均明显高于治疗前,观察组患者的RDQ各症状评分明显低于对照组[胸痛:(1.04±0.22)分比(2.43±1.04)分,烧心:(1.44±0.62)分比(3.23±1.24)分,反酸:(1.25±0.57)分比(2.52±1.32)分,反食:(1.35±0.74)分比(2.68±1.01)分],GLQI评分明显高于对照组[自觉症状:(65.7±6.6)分比(55.2±5.2)分,生理功能状态:(20.6±3.6)分比(18.1±2.3)分,精神、心理状态:(18.1±2.7)分比(16.0±3.2)分,生活、社会状态:(12.4±1.7)分比(10.6±2.1)分,总评分:(115.2±9.4)分比(98.7±10.2)分],差异均有统计学意义(均P＜0.05).治疗后,对照组患者出现吞咽困难4例、腹部胀气3例及切口感染2例,而观察组患者仅出现吞咽困难2例,观察组患者术后并发症发生率明显低于对照组[5.6％ (2/36)比25.0％ (9/36)],差异有统计学意义(P＜0.05).结论 腹腔镜下行食管裂孔疝修补联合胃底折叠术治疗食管裂孔疝合并胃食管反流,可明显改善患者的胃肠道功能及胃反流症状,提高生存质量及降低术后并发症.%Objective To explore the effect and safety of laparoscopic hiatal hernia repair combined with fundoplication in hiatal hernia complicated with gastroesophageal reflux disease.Methods Totally 72 cases of patients with hiatal hernia complicated with gastroesophageal reflux disease from January 2012 to January 2015 were enrolled and randomly divided into control group (36 cases) receiving conventional laparotomy, and observation group (36 cases) receiving laparoscopic hiatal hernia repair combined with fundoplication.The duration of operation time, intraoperative blood loss, recovery time of gastrointestinal function, hospitalization duration, reflux diagnostic questionnaire (RDQ) scores, gastrointestinal quality of life index (GLQI) scores and incidence of complications were compared between groups.Results The duration of operation time, intraoperative blood loss,recovery time of gastrointestinal function after operation and hospitalization duration in observation group were significantly less than those in control group [(76 ± 10) min vs (95 ± 12) min, (28 ± 10) ml vs (77 ±21) ml,(1.2±0.4) d vs (3.6±1.0) d, (6.1 ±1.6) d vs (11.9±2.4) d] (P＜0.05).Before treatment, observation group and control group were not significantly different regarding the RDQ scores [pectoralgia:(4.73 ±2.31) scores vs (4.82 ±2.53) scores, heartburn: (6.13 ±2.43) scores vs (6.02 ± 1.93) scores,sour regurgitation: (4.29 ± 2.12) scores vs (4.36 ± 2.31) scores, gastroesophageal reflux: (5.02 ±2.17) scores vs (5.13 ±2.62) scores] and GLQI scores [subjective symptom: (48.4 ±9.1) scores vs (49.0 ±8.9) scores, physiological function state : (15.3 ± 5.1) scores vs (15.4 ± 5.3) scores, mental state : (12.3 ±4.2) scores vs (12.1 ± 3.6) scores, social status : (8.9 ± 2.5) scores vs (8.7 ± 2.6) scores, total GLQI scores: (84.5 ± 12.5) scores vs (84.8 ± 12.8) scores] (P ＞ 0.05).After treatment, the RDQ scores were significantly reduced and the GLOI scores were significantly increased in both group;the RDQ scores in observation group was significantly lower than those in control group [pectoralgia : (1.04 ± 0.22) scores vs (2.43 ±1.04) scores, heartburn: (1.44 ± 0.62) scores vs (3.23 ± 1.24) scores, sour regurgitation: (1.25 ±0.57) scores vs (2.52 ± 1.32) scores, gastroesophageal reflux: (1.35 ± 0.74) scores vs (2.68 ± 1.01) scores] (P ＜ 0.05);the GLQI scores in observation group were significantly higher than those in control group [subjective symptom : (65.7 ± 6.6) scores vs (55.2 ± 5.2) scores, physiological function state : (20.6 ± 3.6) scores vs (18.1 ± 2.3) scores, mental state : (18.1 ± 2.7) scores vs (16.0 ± 3.2) scores, social status : (12.4 ±1.7) scores vs (10.6 ± 2.1) scores, total GLQI scores : (115.2 ± 9.4) scores vs (98.7 ± 10.2) scores] (P ＜0.05).In control group, dysphagia occurred in 2 cases, abdominal distension occurred in 3 cases, wound infection occurred in 3 cases;in observation group, dysphagia occurred in 2 cases;the incidence of complications in observation group was significantly lower than that in control group [5.6％ (2/36) vs 25.0％ (9/36)] (P ＜ 0.05).Conclusion Laparoscopic hiatal hernia repair combined with fundoplication can improve gastrointestinal function and gastric reflux symptoms, enhance quality of life, and reduce the incidence of complications in treating hiatal hernia complicated with gastroesophageal reflux disease.
展开▼
