胃食管反流病合并食管裂孔疝及哮喘症状的腹腔镜外科治疗

目的探讨腹腔镜食管裂孔疝(hiatal hernia,HH)修补术加胃底折叠术对胃食管反流病(gastroesophageal reflux disease,GERD)合并HH及哮喘症状的疗效。方法收集2008年1月至2012年1月第二炮兵总医院收治的GERD合并HH患者。问卷随访和评价术前及术后胃食管反流病典型症状和哮喘症状评分和并发症。结果共纳入和成功随访476例,其中Ⅰ、Ⅱ、Ⅲ、Ⅵ型HH分别占90.8%、1.1%、5.9%和2.3%。补片植入56例,Nissen和Toupet胃底折叠术分别为310例和166例。平均随访(4.4±1.3)年,术后无严重并发症和死亡。手术总有效率为95.5%,胃食管反流典型症状评分和哮喘症状评分分别从(13.4±2.0)和(18.2±2.9)下降至(3.1±1.7)和(5.2±5.0),差异均有统计学意义(t=11.7、14.4,P均0.001),术后症状评分缓解率分别为76.9%和71.4%。结论腹腔镜下HH修补术加胃底折叠术能有效控制GERD的典型症状及哮喘症状,并且安全性良好。胃食管反流、食管裂孔疝和哮喘三者之间存在相关性,值得进一步的探讨和研究。     

腹腔镜手术治疗食管裂孔疝的42体会

目的探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性。方法对42例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,其中32例行胃底360°折叠术(Nissen术),10例行胃底270°部分折叠术(Toupet术)。39例采用4号丝线缝合修补疝缺口,3例应用补片修补疝缺口。结果42例腹腔镜食管裂孔疝修补术全部成功。手术时间平均(138±22)min,失血平均(62±16)ml;无术后并发症;术后平均住院(5.2±1.9)d。术后症状完全消失32例(76%),好转10例(24%)。结论腹腔镜食管裂孔疝修补术具有疗效确定、安全和创伤小的优点,值得进一步推广应用。     

食管裂孔疝致胃食管反流病合并腹股沟疝患者的外科治疗

目的:探讨食管裂孔疝致胃食管反流病合并腹股沟疝患者的围手术期处理及其安全性。方法:回顾分析2012年10月至2015年10月收治的13例食管裂孔疝致胃食管反流病合并腹股沟疝(15侧)患者的临床资料。均行腹腔镜手术,其中9例行腹腔镜全腹膜外疝修补术,4例行经腹腹膜前疝修补术;9例行单纯食管裂孔疝缝合,2例采用生物补片修补,1例采用强生PHY补片修补,1例行单纯胃底固定。抗反流术式包括Nissen胃底折叠术6例,Dor胃底折叠术4例,Toupet胃底折叠术2例。回顾总结患者的围手术期处理措施。结果:本组患者均无围手术期死亡,术后无严重并发症发生,其中术后切口感染1例,阴囊水肿1例,予以换药、理疗后好转。2例患者术后出现进食哽噎,嘱其少量多餐、细嚼慢咽,1个月后症状消失。合并贫血患者术后血红蛋白恢复至95 g/L,术后中位随访时间为10个月,无复发病例。结论:食管裂孔疝致胃食管反流病合并腹股沟疝患者病情较复杂,手术风险大,难度高,但只要做好充分的术前准备,采用恰当的手术方式,术中谨慎、细致操作,针对性的处理术后出现的各种问题,手术是安全、可行的。     

胃食管反流病的腹腔镜外科治疗

目的:探讨腹腔镜手术治疗胃食管反流病的临床效果.方法:回顾性分析2008年1月—2011年9月对33例胃食管反流病患者行腹腔镜食管裂孔疝修补和胃底折叠术的临床资料.腹腔镜单纯胃底折叠术5例(Toupet式),腹腔镜食管裂孔疝修补加胃底折叠术25例(Nissen式3例,Toupet式22例),腹腔镜单纯食管裂孔疝修补术3例.结果:全组患者手术均获成功,手术时间90～185 min.术后平均住院6d.无中转开腹及死亡病例,无术后严重并发症.术后随访1～24个月,32例临床症状完全消失,1例明显好转.结论:对于胃食管反流性疾病,腹腔镜食管裂孔疝修补和胃底折叠术是一种微创、安全、有效的治疗方法.     

腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效

目的探讨腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝（HH）合并胃食管反流病患者的临床疗效。 方法选择2016年1月至2019年1月河北北方学院附属第二医院收治的108例食管裂孔疝合并胃食管反流病患者开展回顾性研究，按照不同手术方式将患者分为2组，每组患者54例。对照组行常规开腹手术，联合组行腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术，比较2组患者术前及术后6个月反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分。 结果2组术前反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异无统计学意义（P>0.05）；2组患者术后6个月反流症状与术前比较，均得到明显改善，差异有统计学意义（P<0.05）；2组术后反流时间、反流次数、DeMeester评分、食管下括约肌压力及Gerd Q量表评分比较，差异有统计学意义（P<0.05）。联合组患者的手术时间、术中出血量及术后住院时长均明显优于对照组，差异有统计学意义（P<0.05）。 结论腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术对HH合并胃食管反流病患者效果显著，有利于患者身体快速恢复，微创、安全且近期疗效满意。     

腹腔镜食管裂孔疝修补术联合胃底折叠术对胃食管反流病合并食管裂孔疝患者抗反流效果及生活质量的影响

目的探讨腹腔镜食管裂孔疝修补术联合胃底折叠术对胃食管反流病（gastroesophageal reflux disease,GERD）合并食管裂孔疝（hiatus hernia,HH）患者抗反流效果及生活质量的影响。 方法选取新疆维吾尔自治区人民医院消化科住院部自2015年3月至2017年8月收治的78例GERD合并HH患者为研究对象,分为2组。观察组行腹腔镜HH修补术联合胃底折叠术（42例）,对照组行传统开腹术（36例）。随访观察2组患者手术情况、不良反应发生情况以及RDQ和GLQI评分。 结果观察组患者术中出血量和手术时间、术后住院时间、胃肠道功能恢复时间均低于对照组,差异有统计学意义（P<0.05）。术后3及6个月随访中,观察组的RDQ评分低于对照组,GLQI评分高于对照组（P<0.05）,差异均有统计学意义（P<0.05）。观察组术后不良反应发生率为7.14%,对照组术后不良反应发生率为16.67%,但2组差异无统计学意义（P>0.05）。 结论对于GERD合并HH患者,采用腹腔镜HH修补术联合胃底折叠术的手术方案,手术情况及抗反流效果更好,患者生活质量更高。     

腹腔镜Nissen胃底折叠术的临床疗效评价

目的:评价腹腔镜Nissen手术在治疗食管裂孔疝中的优越性。方法:应用腹腔镜行食管裂孔疝修补和胃底折叠术治疗31例食管裂孔疝患者。结果:本组患者手术均获成功,仅1例发生纵隔气肿。术后随访6个月~7年,临床症状完全消失,无一例复发。结论:腹腔镜食管裂孔疝修补和胃底折叠术具有患者创伤小、痛苦少、住院时间短等优点,是当今治疗食管裂孔疝手术的金标准。     

腹腔镜食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝

目的：探讨腹腔镜下行食管裂孔疝修补联合胃底折叠术治疗胃食管反流病合并食管裂孔疝的临床疗效和安全性。 方法：回顾性分析2012年1月—2014年2月在我院进行食管裂孔疝修补联合胃底折叠术的58例胃食管反流病合并食管裂孔疝患者临床资料,其中36例在腹腔镜下行食管裂孔疝修补联合胃底折叠术（观察组）,22例患者行开腹手术（对照组）。观察并比较两组患者手术时间、术中出血量、术后住院时间、术后胃肠道功能恢复时间及术后并发症发生情况,手术前及手术后4个月进行反流性疾病问卷（RDQ）调查结果。 结果：观察组手术时间、术后住院时间、术后胃肠道功能恢复时间均明显短于对照组（均P<0.05）;观察组术中出血量及术后并发症发生情况均明显优于对照组（P<0.05）;两组患者RDQ评分显示术后4个月症状均有不同程度的改善,观察组患者症状改善程度优于对照组患者（均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胃食管反流病合并食管裂孔疝,疗效显著,安全性好,可积极应用于临床上胃食管反流病合并食管裂孔疝的治疗。     

腹腔镜胃底折叠术联合胃袖状切除术治疗肥胖合并胃食管反流病北大核心CSCD

目的 观察腹腔镜胃底折叠术联合胃袖状切除术治疗肥胖合并胃食管反流病的疗效.方法 回顾性分析2014年2-10月新疆维吾尔自治区人民医院微创外科接受腹腔镜胃底折叠术联合袖状胃切除术治疗的5例肥胖合并胃食管反流病患者的临床资料.结果 全组病例均顺利完成腹腔镜食管裂孔疝缝合修补术＋保留部分鱼鳍状胃底的胃袖状切除术＋不同类型胃底折叠术,1例联合行腹腔镜胆囊切除术,无l例中转开腹.平均手术时间（157±27） min,平均术后住院（5.7±1.5）d.术后随访3～6个月,术后1、3、6个月平均减重分别为（13.1±2.7） kg、（25.7±3.8） kg、（37.3±4.1） kg,多余体重减少百分比分别为24.7％±3.3％、47.3％±6.3％、65.8％±8.7％.术后5例患者胃食管反流症状均完全缓解,3例合并糖耐量异常和高血压的患者术后3个月血糖和血压均恢复正常.无严重并发症发生.结论 腹腔镜胃底折叠术联合胃袖状切除术可能成为治疗肥胖合并胃食管反流病或食管裂孔疝的新手术方法之一.     

腹腔镜食道裂孔疝修补术的临床效果分析：附51例报告

目的:探讨腹腔镜食道裂孔疝修补术的安全性和疗效。方法:回顾分析2012年7月—2016年7月51例行腹腔镜食道裂孔疝修补术的患者临床资料。结果:51例患者均顺利接受腹腔镜食道裂孔疝修补术。术中裂孔缝合修补后均采用补片加强固定。对无明显禁忌证患者,同时行Dor胃底折叠术。平均时间(100±15.4)min,术中出血量平均(28±15.4)mL,术后平均住院时间2d。术后胸痛、进食后哽噎等疝囊压迫症状明显缓解,反酸,烧心等反流症状也得到明显改善。无严重并发症发生,均在4周内恢复正常饮食。平均随访32个月,未见裂孔疝复发及补片相关并发症。结论:腹腔镜食道裂孔疝修补术是安全有效的手术方式,食道裂孔缝合关闭后使用补片加强修补可以降低裂孔疝的复发率。     

腹腔镜辅助下小切口巨大腹壁疝修补术

Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.     

腹腔镜辅助下小切口巨大腹壁疝修补术

Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.     

Inguinal hernia repair in the Amsterdam region 1994–1996

In the Netherlands, approximatey 30,000 inguinal hernia repairs are performed yearly. At least 15% are for recurrence. New procedures are being introduced creating discussion on which technique is the best. Currently it is not possible to choose on evidence alone because of the long follow-up that is needed.In 1996 an inventory was taken of all inguinal hernia repairs that were performed in the Amsterdam region (9 hospitals). These results were compared with the results from a similar study performed in 1994. Major changes in treatment strategy were noted. The Bassini repair was replaced by Shouldice and Lichtenstein techniques. There was a significant increase in the use of prostheses for both primary and recurrent inguinal hernias. There was no significant decrease in the percentage of operations performed for recurrent hernia from 19.5% to 16.8%. However, there was a significant decrease in operations performed for early recurrences (5.1%–3.4%) (p=0.05). These results suggest that the Shouldice and Lichtenstein repairs may be superior to the Bassini repair in terms of early hernia recurrence.     

全腹膜外补片植入术中补片不固定的实验研究

目的评价全腹膜外补片植入术中补片不固定的安全性和有效性。方法将50只SD大鼠建立疝缺损(3cm2)模型,按随机数字表分为2组,使用聚丙烯补片(12 cm2)采用腹膜外补片植入术进行修复。甲组为补片固定组,乙组为补片不固定组。大鼠于术后不同时间分批处死,记录补片的挛缩度、腹壁抗张强度以及组织细胞学变化。结果所有大鼠术后腹腔均无粘连。2组大鼠在术后7 d、14 d、30 d、60 d和90 d补片的挛缩度分别为6.7%±1.3%vs 7.3%±1.5%、12.3%±1.3%vs 12.4%±1.6%、14.0%±2.0%vs 14.5%±1.3%、17.4%±2.1%vs 18.4%±1.5%和18.9%±2.2%vs19.5%±2.6%(P>0.05);2组大鼠的腹壁抗张强度分别为(288.4±8.4)mm Hg vs(286.6±10.2)mm Hg、(300.4±11.2)mm Hg vs(298.8±11.4)mm Hg、(305.0±11.7)mm Hg vs(303.3±16.1)mm Hg、(309.0±10.8)mm Hg vs(307.6±8.9)mm Hg和(311.8±9.8)mm Hg vs(310.0±8.6)mm Hg(P>0.05);2组大鼠的组织细胞学变化一致。结论当补片面积是大鼠疝缺损的4倍以上时,不固定的腹膜外补片植入术是安全有效的。     

Review of the management of recurrent inguinal hernia

Background: There is little available evidence on the optimal management of recurrent inguinal hernia, particularly if the original procedure involved the use of mesh. This study was a review of recurrent hernia repair in a district hospital, involving both laparoscopic and open procedures. Methods: The case notes of all patients who had a repair of a recurrent hernia between 1991 and 2000, inclusive, were examined; 171 procedures were included. Where known, the original repair was a nylon darn in 31%, mesh repair in 18%, and laparoscopic repair in 8%. Results: The recurrent hernia was repaired using a Lichtenstein open mesh technique in 63% and by the totally extraperitoneal (TEP) method in 22%. Complication rates were highest after emergency surgery (all had open surgery), where 71% had complications and one patient died. For elective repairs, complication rates were similar after open (13%) and TEP (8%) repairs. The duration of hospital stay was also similar (1.2 vs 1.3 days, respectively), and a single recurrence was seen in each group. Patients with recurrence after primary mesh repair were also managed by both techniques with similar results. Open re-operation for mesh failure was technically straightforward. Conclusions: Most recurrent hernias are still repaired by open techniques. There was no convincing evidence of different outcomes for open and TEP repairs in this review. Even when the original hernia repair involved the use of mesh, further open repair by an experienced surgeon is justified.     

腹腔镜辅助下小切口巨大腹壁疝修补术

目的 探讨腹腔镜辅助下小切口巨大腹壁疝修补术的经验和体会.方法 分析2009年1月至2009年9月收治的18例采用腹腔镜辅助下小切口修补巨大腹壁疝的患者资料,观察手术时间、隐匿疝、小切口长度、浆液肿、住院时间、慢性疼痛、复发等情况.结果 18例患者均顺利完成手术,手术时间(129 ±19)min,切口长度(5.6 ±1.0)cm,发现隐匿疝3例,术后发生浆液肿1例,术后住院时间(5.1±1.2)d,术后疼痛持续大于3个月的1例,无切口感染和肠道及腹腔脏器损伤,无手术死亡.全组患者随访时间(8.6±1.6)个月无复发.结论 腹腔镜辅助下小切口修补巨大腹壁疝是一种安全可靠的手术方法,有效减少了术后并发症的发生,达到了腹壁塑形的效果.     

Classification of groin hernia: Milestones

Do we have true “milestones” along the hernia-classification route? I am not certain; modifications have been presented along the way, and each presentation (partially discussed herein) should be studied by every student of herniology and personal decisions made. In developing classifications, we should beware of too many hernia types. We must focus our attention and decisions upon each abdominal wall defect. These defects have been nicely described in readily available anatomic texts. Following this route, each surgeon may determine with ease and minimal complexity the appropriate approach and repair with confidence of cure.     

Hernia Surgery: From Guidelines to Clinical Practice

INTRODUCTION

Over the last 30 years, hernia surgery has developed into an evidence-based practice assisted by the development of guidelines.

MATERIALS AND METHODS

Prior to 1993, best practice in the UK was a nylon darn repair under general anaesthesia as an in-patient with prolonged recovery. The publication of The Royal College of Surgeons of England (RCSE) Guidelines on Groin Hernia Repair stimulated debate and coincided with the introduction of mesh hernioplasty and laparoscopic techniques. Further evolution of hernia management has occurred to enable the production of the European Hernia Society (EHS) guidelines in 2008.

RESULTS

The EHS guidelines cover all aspects of abdominal wall surgery including: indications for operation; investigations; organising surgical care; techniques; local anaesthesia; after-care, complications and outcome; and information for patients.

CONCLUSIONS

Surgeons have many choices when selecting an appropriate hernia operation for an individual patient. The EHS guidelines provide a basis for this decision-making.