腹腔镜食管裂孔疝修补术联合不同抗反流术式治疗食管裂孔疝合并胃食管反流病的临床比较
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摘要
目的探讨并比较腹腔镜食管裂孔疝修补术联合不同抗反流术式治疗食管裂孔疝(HH)合并胃食管反流病(GERD)的效果。方法回顾性分析该院2014年1月-2017年1月行腹腔镜食管裂孔疝修补术联合抗反流术治疗的HH合并GERD患者67例的病例资料。根据抗反流术式的方法分为3组,其中29例采用腹腔镜Nissen胃底折叠术(Nissen组),18例行腹腔镜Toupet胃底折叠术(Toupet组),20例行腹腔镜Dor胃底折叠术(Dor组)。比较3组手术情况及术后恢复情况,术后随访1年,观察手术前后胃镜、高分辨率食管测压及24 h食管pH监测结果,发放GERD-Q症状评分评估患者GERD症状,使用GERD相关生命质量量表(GERD-HROL),记录两组术后并发症发生率、手术失效率及复发率。结果 3组患者手术情况、术后恢复情况及术后第1年胃镜检查情况比较,差异均无统计学意义(P>0.05);Toupet组术后1年食管下括约肌(LES)静息呼吸平均值低于Nissen组和Dor组,反流时间、反流次数、无效吞咽高于Nissen组和Dor组,差异均有统计学意义(P <0.05),但Nissen组和Dor组比较,差异无统计学意义(P>0.05),3组术后1年LES静息压最小值、24 h pH阻抗监测、DeMeester评分、GERD-Q症状评分和GERD-HROL量表评分比较,差异均无统计学意义(P>0.05);3组患者术后并发症发生率、手术无效率及复发率比较,差异均无统计学意义(P>0.05)。结论腹腔镜食管裂孔疝修补术联合3种胃底折叠术治疗HH合并GERD均可起到抗反流的效果,但Nissen和Dor手术在改善LES静息呼吸压力值、反流和无效吞咽方面的效果优于Toupet手术。
Objective To explore and compare the effects of laparoscopic repair of esophageal hiatal hernia combined with different anti-reflux methods in treatment of esophageal hiatal hernia(HH) with gastroesophageal reflux disease(GERD). Methods The clinical data of 67 patients with HH and GERD who were treated by laparoscopic repair of esophageal hiatal hernia combined with anti-reflux operation in the hospital from January2014 to January 2017 were retrospectively analyzed. According to the anti-reflux operation, they were divided into 3 groups. Among them, 29 cases were treated by laparoscopic Nissen fundoplication(Nissen group), 18 cases were treated by laparoscopic Toupet fundoplication(Toupet group), and 20 cases were treated by laparoscopic Dor fundoplication(Dor group). The operation and postoperative recovery were compared between groups, and all groups were followed up for 1 year. The results of gastroscopy, high-resolution esophageal manometry and24 h esophageal pH monitoring were observed before and after operation. GERD symptoms were evaluated with GERD-Q symptom score, and the gastroesophageal reflux disease related quality of life scale(GERD-HROL) was also issued. The postoperative complications, operative failure rates and recurrence rates in the two groups were recorded. Results There was no significant difference among the 3 groups in operative situation, postoperative recovery or gastroscopy in 1 year after operation(P > 0.05). The average value of LES resting respiration of Toupet group at 1 year after operation was lower than that of Nissen group or Dor group, while the reflux time, reflux times and ineffective swallowing were longer/more than those of Nissen group or Dor group(P < 0.05), but there was no statistically significant difference between Nissen group and Dor group(P > 0.05). There was no statistically significant difference among the 3 groups in the minimum value of LES resting pressure in 1 year after operation, 24 h pH impedance monitoring, DeMeester score, GERD-Q symptom score, GERD-HROL scale score, the incidence of postoperative complications, the rate of operative failure or the recurrence rate(P > 0.05). Conclusion Laparoscopic repair of esophageal hiatal hernia combined with three kinds of fundoplication methods can achieve anti-reflux effect in the treatment of HH with GERD. However, Nissen fundoplication and Dor fundoplication are superior to Toupet fundoplication in improving LES resting respiratory pressure, reflux and ineffective swallowing.
Objective To explore and compare the effects of laparoscopic repair of esophageal hiatal hernia combined with different anti-reflux methods in treatment of esophageal hiatal hernia(HH) with gastroesophageal reflux disease(GERD). Methods The clinical data of 67 patients with HH and GERD who were treated by laparoscopic repair of esophageal hiatal hernia combined with anti-reflux operation in the hospital from January2014 to January 2017 were retrospectively analyzed. According to the anti-reflux operation, they were divided into 3 groups. Among them, 29 cases were treated by laparoscopic Nissen fundoplication(Nissen group), 18 cases were treated by laparoscopic Toupet fundoplication(Toupet group), and 20 cases were treated by laparoscopic Dor fundoplication(Dor group). The operation and postoperative recovery were compared between groups, and all groups were followed up for 1 year. The results of gastroscopy, high-resolution esophageal manometry and24 h esophageal pH monitoring were observed before and after operation. GERD symptoms were evaluated with GERD-Q symptom score, and the gastroesophageal reflux disease related quality of life scale(GERD-HROL) was also issued. The postoperative complications, operative failure rates and recurrence rates in the two groups were recorded. Results There was no significant difference among the 3 groups in operative situation, postoperative recovery or gastroscopy in 1 year after operation(P > 0.05). The average value of LES resting respiration of Toupet group at 1 year after operation was lower than that of Nissen group or Dor group, while the reflux time, reflux times and ineffective swallowing were longer/more than those of Nissen group or Dor group(P < 0.05), but there was no statistically significant difference between Nissen group and Dor group(P > 0.05). There was no statistically significant difference among the 3 groups in the minimum value of LES resting pressure in 1 year after operation, 24 h pH impedance monitoring, DeMeester score, GERD-Q symptom score, GERD-HROL scale score, the incidence of postoperative complications, the rate of operative failure or the recurrence rate(P > 0.05). Conclusion Laparoscopic repair of esophageal hiatal hernia combined with three kinds of fundoplication methods can achieve anti-reflux effect in the treatment of HH with GERD. However, Nissen fundoplication and Dor fundoplication are superior to Toupet fundoplication in improving LES resting respiratory pressure, reflux and ineffective swallowing.
引文
[1]ASANUMA K,IIJIMA K,SHIMOSEGAWA T.Gender difference in gastro-esophageal reflux diseases[J].World J Gastroenterol,2016,22(5):1800-1810.
[2]TESTONI P A,MAZZOLENI G,TESTONI S G.Transoral incisionless fundoplication for gastro-esophageal reflux disease:techniques and outcomes[J].World J Gastrointest Pharmacol Ther,2016,7(2):179-189.
[3]FRANCESCO T,DANIELE M,ALEXANDROS I,et al.A new mechanism of gastroesophageal reflux in hiatal hernia documented by high-resolution impedance manometry:a case report[J].Ann Gastroenterol,2016,29(4):548-550.
[4]张成,李俊生,克力木,等.2013年美国胃肠内镜外科医师协会食管裂孔疝治疗指南解读(二)[J].中华胃食管反流病电子杂志,2015,2(2):68-69.[4]ZHANG C,LI J S,KE L M,et al.Interpretation of the guidelines for the treatment of esophageal hiatal hernia by society of American gastrointestinal and endoscopic surgeons in 2013[J].Chinese Journal of Gastroesphageal Reflux Disease:Electronic Edition,2015,2(2):68-69.Chinese
[5]中华医学会消化病学分会.2014年中国胃食管反流病专家共识意见[J].中华消化杂志,2014,34(10):649-661.[5]Chinese Society of Gastroenterology.Expert consensus opinion of Chinese gastroesophageal reflux disease in 2014[J].Chinese Journal of Digestion,2014,34(10):649-661.Chinese
[6]GARG H,VIGNESHWARAN B,AGGARWAL S,et al.Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients[J].J Minim Access Surg,2017,13(2):103-108.
[7]AKKURT G,SüRGIT?,ATA?H,et al.Dynamic MRI evaluation of the gastric fundus and splenic circulation to assess the gastric breves dissection during laparoscopic Nissen fundoplication[J].Open Access Maced J Med Sci,2018,6(2):320-325.
[8]DESIDERIO J,TRASTULLI S,RICCI F,et al.Robotic Nissen fundoplication for gastro-oesophageal reflux disease with hiatal hernia(with video)[J].J Visc Surg,2016,153(2):145-146.
[9]李治仝,季锋,韩新巍,等.食管裂孔疝对腹腔镜下抗反流手术效果的影响[J].中华普通外科杂志,2016,31(8):693-694.[9]LI Z T,JI F,HAN X W,et al.Effect of hiatal hernia on the effects of laparoscopic anti-reflux surgery[J].Chinese Journal of General Surgery,2016,31(8):693-694.Chinese
[10]苏福增,张成,克力木,等.腹腔镜Nissen、Toupet和Dor胃底折叠术治疗食管裂孔疝合并胃食管反流病的疗效对比分析[J].中华胃肠外科杂志,2016,19(9):1014-1020.[10]SU F Z,ZHANG C,KE L M,et al.Efficacy comparison of laparoscopic Nissen,Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease[J].Chinese Journal of Gastrointestinal Surgery,2016,19(9):1014-1020.Chinese
[11]艾克拜尔·艾力,克力木·阿不都热依木,张成,等.腹腔镜胃底折叠抗反流术联合胃袖状切除术动物实验研究[J].中国实用外科杂志,2015,35(2):211-213.[11]AIKEBAIER A,KELIMU A,ZHANG C,et al.Establishment of laparoscopic fundoplication with sleeve gastrectomy in a porcine model[J].Chinese Journal of Practical Surgery,2015,35(2):211-213.Chinese
[12]梁明强,朱勇,郑炜,等.腹腔镜下治疗食管裂孔疝55例报告[J].中国微创外科杂志,2014,14(7):612-614.[12]LIANG M Q,ZHU Y,ZHENG W,et al.Clinical experience of laparoscopic repair of esophageal hiatal hernia[J].Chinese Journal of Minimally Invasive Surgery,2014,14(7):612-614.Chinese
[13]尹兴瑞,克力木·阿不都热依木,阿扎提江,等.腹腔镜下食管裂孔疝的外科治疗进展[J].腹腔镜外科杂志,2015,20(12):943-945.[13]YIN X R,KELIMU A,AZA T J,et al.Progress in laparoscopic surgical treatment for hiatal hernia[J].Journal of Laparoscopic Surgery,2015,20(12):943-945.Chinese
[14]丁轶人,江涌,葛玮,等.四孔法腹腔镜手术治疗食管裂孔疝的疗效分析[J].腹腔镜外科杂志,2015,20(6):423-425.[14]DING Y R,JIANG Y,GE W,et al.Analysis of curative effect of four-port laparoscopic operation for the treatment of esophageal hiatal hernia[J].Journal of Laparoscopic Surgery,2015,20(6):423-425.Chinese
[15]刘宁,邰沁文,曹俊,等.超重患者胃食管反流病的腹腔镜治疗[J].中国微创外科杂志,2014,14(2):160-163.[15]LIU N,TAI Q W,CAO J,et al.Laparoscopic treatment for overweight patients with gastroesophageal reflux disease[J].Chinese Journal of Minimally Invasive Surgery,2014,14(2):160-163.Chinese
[16]刁海鑫,吴文溪,邓勇.腹腔镜引导下修补手术治疗食管裂孔疝疗效及对患者生活质量的影响[J].中国内镜杂志,2015,21(10):1065-1068.[16]DIAO H X,WU W X,DENG Y.Effect of laparoscopic repair and impact on quality of life in patients with hiatal hernia[J].China Journal of Endoscopy,2015,21(10):1065-1068.Chinese
[2]TESTONI P A,MAZZOLENI G,TESTONI S G.Transoral incisionless fundoplication for gastro-esophageal reflux disease:techniques and outcomes[J].World J Gastrointest Pharmacol Ther,2016,7(2):179-189.
[3]FRANCESCO T,DANIELE M,ALEXANDROS I,et al.A new mechanism of gastroesophageal reflux in hiatal hernia documented by high-resolution impedance manometry:a case report[J].Ann Gastroenterol,2016,29(4):548-550.
[4]张成,李俊生,克力木,等.2013年美国胃肠内镜外科医师协会食管裂孔疝治疗指南解读(二)[J].中华胃食管反流病电子杂志,2015,2(2):68-69.[4]ZHANG C,LI J S,KE L M,et al.Interpretation of the guidelines for the treatment of esophageal hiatal hernia by society of American gastrointestinal and endoscopic surgeons in 2013[J].Chinese Journal of Gastroesphageal Reflux Disease:Electronic Edition,2015,2(2):68-69.Chinese
[5]中华医学会消化病学分会.2014年中国胃食管反流病专家共识意见[J].中华消化杂志,2014,34(10):649-661.[5]Chinese Society of Gastroenterology.Expert consensus opinion of Chinese gastroesophageal reflux disease in 2014[J].Chinese Journal of Digestion,2014,34(10):649-661.Chinese
[6]GARG H,VIGNESHWARAN B,AGGARWAL S,et al.Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients[J].J Minim Access Surg,2017,13(2):103-108.
[7]AKKURT G,SüRGIT?,ATA?H,et al.Dynamic MRI evaluation of the gastric fundus and splenic circulation to assess the gastric breves dissection during laparoscopic Nissen fundoplication[J].Open Access Maced J Med Sci,2018,6(2):320-325.
[8]DESIDERIO J,TRASTULLI S,RICCI F,et al.Robotic Nissen fundoplication for gastro-oesophageal reflux disease with hiatal hernia(with video)[J].J Visc Surg,2016,153(2):145-146.
[9]李治仝,季锋,韩新巍,等.食管裂孔疝对腹腔镜下抗反流手术效果的影响[J].中华普通外科杂志,2016,31(8):693-694.[9]LI Z T,JI F,HAN X W,et al.Effect of hiatal hernia on the effects of laparoscopic anti-reflux surgery[J].Chinese Journal of General Surgery,2016,31(8):693-694.Chinese
[10]苏福增,张成,克力木,等.腹腔镜Nissen、Toupet和Dor胃底折叠术治疗食管裂孔疝合并胃食管反流病的疗效对比分析[J].中华胃肠外科杂志,2016,19(9):1014-1020.[10]SU F Z,ZHANG C,KE L M,et al.Efficacy comparison of laparoscopic Nissen,Toupet and Dor fundoplication in the treatment of hiatal hernia complicated with gastroesophageal reflux disease[J].Chinese Journal of Gastrointestinal Surgery,2016,19(9):1014-1020.Chinese
[11]艾克拜尔·艾力,克力木·阿不都热依木,张成,等.腹腔镜胃底折叠抗反流术联合胃袖状切除术动物实验研究[J].中国实用外科杂志,2015,35(2):211-213.[11]AIKEBAIER A,KELIMU A,ZHANG C,et al.Establishment of laparoscopic fundoplication with sleeve gastrectomy in a porcine model[J].Chinese Journal of Practical Surgery,2015,35(2):211-213.Chinese
[12]梁明强,朱勇,郑炜,等.腹腔镜下治疗食管裂孔疝55例报告[J].中国微创外科杂志,2014,14(7):612-614.[12]LIANG M Q,ZHU Y,ZHENG W,et al.Clinical experience of laparoscopic repair of esophageal hiatal hernia[J].Chinese Journal of Minimally Invasive Surgery,2014,14(7):612-614.Chinese
[13]尹兴瑞,克力木·阿不都热依木,阿扎提江,等.腹腔镜下食管裂孔疝的外科治疗进展[J].腹腔镜外科杂志,2015,20(12):943-945.[13]YIN X R,KELIMU A,AZA T J,et al.Progress in laparoscopic surgical treatment for hiatal hernia[J].Journal of Laparoscopic Surgery,2015,20(12):943-945.Chinese
[14]丁轶人,江涌,葛玮,等.四孔法腹腔镜手术治疗食管裂孔疝的疗效分析[J].腹腔镜外科杂志,2015,20(6):423-425.[14]DING Y R,JIANG Y,GE W,et al.Analysis of curative effect of four-port laparoscopic operation for the treatment of esophageal hiatal hernia[J].Journal of Laparoscopic Surgery,2015,20(6):423-425.Chinese
[15]刘宁,邰沁文,曹俊,等.超重患者胃食管反流病的腹腔镜治疗[J].中国微创外科杂志,2014,14(2):160-163.[15]LIU N,TAI Q W,CAO J,et al.Laparoscopic treatment for overweight patients with gastroesophageal reflux disease[J].Chinese Journal of Minimally Invasive Surgery,2014,14(2):160-163.Chinese
[16]刁海鑫,吴文溪,邓勇.腹腔镜引导下修补手术治疗食管裂孔疝疗效及对患者生活质量的影响[J].中国内镜杂志,2015,21(10):1065-1068.[16]DIAO H X,WU W X,DENG Y.Effect of laparoscopic repair and impact on quality of life in patients with hiatal hernia[J].China Journal of Endoscopy,2015,21(10):1065-1068.Chinese