腹腔镜下食管裂孔疝无张力修补术

 为探讨腹腔镜下应用补片行食管裂孔疝修补的临床效果，2006年8月至2009年4月对本院40例食管裂孔疝患者在腹腔镜下用超声刀进行食管裂孔疝游离后，应用腔内缝合器将补片钉合食管裂孔边缘，完成食管裂孔疝修补术，并同期给予部分胃底折叠术。40例患者均成功地在腹腔镜下行食管裂孔疝无张力修补术，其中Ⅰ型13例，Ⅱ型4例，Ⅲ型15例，Ⅳ型8例。所有患者均有明显的烧心返酸症状；部分患者伴有胸骨后及剑突下疼痛、恶心、呕吐、夜间睡眠时呛咳、吞咽困难等症状。手术用时70～170min，平均90min。术中出血10～110mL，平均20mL，均无输血。无死亡病例。所有患者术后症状完全缓解。术后住院3～30d，中位平均住院日为5d。对40例患者术后进行3～25个月的随访（平均12个月），未发现食管裂孔疝复发病例及有关补片并发症的发生。证明腹腔镜下食管裂孔疝无张力修补术是一种安全有效的微创方法，具有创伤少、恢复快、术后复发率低等特点。

Laparoscopic Tension-free Repair for the Esophageal Hiatal Hernia

To investigate the clinical effects of the laparoscopic tension-free repair of the esophageal hiatal hernia using meshes, from August 2006 to April 2009, 40 patients with esophageal hiatal hernia were treated by ultrasonic scalpel under laparoscopy to isolate esophageal hiatal hernia, which was then repaired using meshes. Toupet partial fundop lication was performed. For all patients, the laparoscope tension-free repair was successfully performed (13 of type I, 4 of type II, 15 of type III and 8 of type IV). All patients have the symptoms of heartburn and regurgitation; for some patients the symptoms are accompanied with nausea, vomit and dysphagia. The operation lasts 90min in average (70～170min) with the blood loss between 10~210mL. No case of death. 10 patients were completely recovered after the operation. The mean postoperative hospital stay was 5d(3～30d). The patients were followed up for 3～25 months (12 months in average), no case of recurrence of the hernia, and no complication with regards to the use of meshes. Laparoscopic mesh of tension-free prosthesis is shown to be a secure and minimally invasive operation for esophageal herination, with a very small recurrence rate.