Objective To investigate the clinical effect of modified Nissen fundoplication for the treatment of sliding esophageal hiatal hernia.Methods A retrospective analysis was made on 22 cases of sliding esophageal hiatal hernia from March 2012 to March 2017 in our hospital.All the patients were given a modified Nissen operation, during which the stomach was lifted to 2-3 cm above the cardiac orifice and the esophagus was wrapped around with double suture for 180 degrees to place below the diaphragm.Among them, 18 cases were treated by thoracic approach, and the other 4 cases by abdominal approach.Results The average operation time was 72 min (range, 59-117 min).The patients were given liquid diet at 24-48 h after operation.Except for 1 case of mild esophageal reflux after oral administration of acid suppression, there were no serious complications and death cases.The postoperative hospitalization time was 7-14 d (average, 9 d).The X-ray barium meal examination under lying head down in 22 cases at two weeks after operation showed no gastroesophageal reflux.Endoscopic esophageal mucosal morphology classification was significantly better than preoperative (Z=-4.884, P=0.000).The 24 h esophageal pH monitoring DeMeester score significantly decreased at 2 weeks after surgery (5.20±2.33) points than before operation (32.30±11.98) points (t=11.824, P=0.000).The gastroesophageal reflux questionnaire score before operation (8.5±2.3) points was significantly higher than 2 weeks after operation (6.7±2.8) points (t=4.002, P=0.000), which indicated that the symptoms of the patients were relieved or disappeared.Follow-ups for two months to 5 years (median, 32 months) found no hiatus hernia recurrence or obvious reflux symptoms.Conclusion Modified Nissen surgery is a safe and effective method for sliding hiatal hernia, which simplify the operation process, reduce the surgical complications of esophageal stenosis derived from 360 degrees of esophageal suture in standard Nissen procedure, and improve anti-reflux effect.%目的 探讨改良Nissen胃底折叠手术治疗滑动性食管裂孔疝的临床效果. 方法 2012年3月~2017年3月我科对22例滑动性食管裂孔疝行改良Nissen术(经胸入路手术18例,腹腔镜手术4例),即胃底上提至贲门口上方2~3 cm,包绕双层缝合固定食管180°,并置于膈肌下方. 结果 手术时间平均72 min(59~117 min),术后24~48 h进食流质饮食.除1例术后出现轻度食管返流经口服抑酸剂缓解外,其余无严重并发症及死亡,均顺利恢复出院,术后住院时间7~14 d,平均9 d.22例术后2周平卧头低位下X线钡餐检查,无胃食管反流;胃镜下食管黏膜形态分级明显优于术前(Z=-4.884,P=0.000);24 h食管pH连续监测,DeMeester评分术前(32.30±11.98)分,明显高于术后2周(5.20±2.33)分(t=11.824, P=0.000).胃食管反流问卷调查表术前就诊时(8.5±2.3)分,明显高于术后2周(6.7±2.8)分(t=4.002, P=0.000),提示患者症状明显缓解或消失.22例随访2周~5年,中位时间32个月,未见食管裂孔疝复发,无明显反流症状.结论 改良Nissen手术是治疗滑动性食管裂孔疝安全有效的方法,简化手术流程,减少标准Nissen手术包绕缝合食管360°所带来的食管狭窄并发症,同时抗反流效果也明显提高.
展开▼
