摘要
目的:探讨腹腔镜下食管裂孔疝修补术+保留胃底折叠术+胃袖状切除术治疗食管裂孔疝合并肥胖症的近期临床疗效及安全性。方法:回顾性分析2015年1月-2017年1月本院收住并行腹腔镜下食管裂孔疝修补术+保留胃底折叠术+胃袖状切除术治疗的24例食管裂孔疝合并肥胖症患者的临床资料。其中行Nissen、Toupet和Dor胃底折叠术分别为11、5、8例。观察患者术后胃食管反流及肥胖相关指标的变化情况。结果:24例患者均在腹腔镜下顺利完成手术。手术时间119~185 min,平均165.6 min;术中出血量85~291 m L,平均151.4 m L;术后住院时间5~11 d,平均6.8 d。术后1、3、6、12、24个月平均减重分别为(9.3±1.8)、(15.9±3.1)、(26.5±3.9)、(36.3±4.2)、(44.9±4.6)kg。患者术后肥胖相关并发症均有不同程度的好转或治愈,反酸、胃灼热等胃食管反流相关症状完全缓解。1例患者术后出现切口感染,经积极换药处理后痊愈。无吞咽困难、吻合口瘘、营养不良等严重并发症发生。结论:腹腔镜下食管裂孔疝修补术+保留胃底折叠术+胃袖状切除术治疗食管裂孔疝合并肥胖症是安全可行的,值得临床进一步推广。
Objective：To investigate the clinical efficacy and safety of hiatal hernia repair＋fundoplication＋laparoscopic sleeve gastrectomy in the treatment of hiatus hernia and obesity.Method：The clinical data of 24 cases treated by hiatal hernia repair＋fundoplication＋laparoscopic sleeve gastrectomy in our hospital from January 2015 to January 2017 were retrospectively analyzed.11 cases were treated by Nissen fundoplication,5 cases were treated by Toupet fundoplication and 8 cases were treated by Dor fundoplication.The changing situation of indexs were observed in postoperative gastroesophageal reflux and obesity.Result：All cases were successfully completed the operation under laparoscope.The operation time was 119 to 185 min,the average operation time was 165.6 min;the intraoperative bleeding was 85 to 291 m L,the average was 151.4 m L;the hospital stay after operation was 5 to 11 d, the average was 6.8 d.The average weight reduction of all patients after operation in 1,3,6,12 and 24 months were（9.3±1.8）,（15.9±3.1）,（26.5±3.9）,（36.3±4.2）,（44.9±4.6）kg.The complications of obesity were better or cured in different degrees,the acid regurgitation,heartburn and other symptoms of gastroesophageal reflux were completely remitted.The incision infection was occurred in 1 case,the patient was cured after change dressing.There were no serious complications.Conclusion：The treatment of hiatal hernia repair＋fundoplication and laparoscopic sleeve gastrectomy in hiatal hernia and obesity is safe and feasible.It is worthy of further clinical application.
作者
邓镜龙
李晓君
张家棋
DENG Jinglong;LI Xiaojun;ZHANG Jiaqi(Changpo Branch Hospital Attached to the People’s Hospital of Gaozhou,Gaozhou 525242,Chin)
出处
《中国医学创新》
CAS
2018年第15期96-99,共4页
Medical Innovation of China
基金
广东省茂名市科技计划项目(2016112)
