解放军医学杂志2025，Vol.50Issue(9)：1122-1128,7.DOI:10.11855/j.issn.0577-7402.0295.2024.1014
腹腔镜食管裂孔疝修补术联合Toupet或Dor胃底折叠术治疗食管裂孔疝的疗效分析
Comparative analysis of the efficacy of laparoscopic hiatal hernia repair combined with Toupet or Dor fundoplication for esophageal hiatal hernia
摘要
Abstract
Objective To investigate the postoperative efficacy of laparoscopic hiatal hernia repair(LHHR)combined with Toupet or Dor fundoplication for the treatment of esophageal hiatal hernia(HH).Methods A retrospective analysis was conducted on the case data of HH patients who underwent LHHR combined with Toupet(Toupet group,n=53)and Dor(Dor group,n=53)fundoplication between December 2018 and December 2022 in Department of General Surgery of Gansu Provincial Hospital.Intraoperative and postoperative recovery outcomes of both groups were observed.We analyzed and compared the incidence of dysphagia and gastroesophageal reflux disease questionnaire(GERD-Q)scores at preoperative and postoperative intervals of 1 month,6 months,and 1 year.The incidence of postoperative complications and the 1-year recurrence rate were compared between the two groups.Additionally,factors influencing postoperative dysphagia within the first month were examined.Results The differences between the two groups in operation time,intraoperative bleeding,postoperative ventilation time,postoperative extubation time and hospitalization time were not statistically significant(P>0.05).There was no significant difference in the incidence of immediate postoperative dysphagia in two groups(P>0.05).Furthermore,the differences between the two groups in the incidence of postoperative complications,such as bloating,abdominal pain and diarrhea,were not statistically significant(P>0.05).The incidence of dysphagia in Toupet group was higher than that in Dor group at 1 month postoperatively,and the difference was statistically significant(P=0.017);but the difference in the incidence of dysphagia between the two groups at 6 months and 1 year postoperatively was not statistically significant(P=0.767,1.000).The results of binary logistic regression analysis showed that both surgical procedure(OR=2.613,95%CI 1.141-5.983,P=0.023)and esophageal contractile reserve function(OR=2.921,95%CI 1.203-7.095,P=0.018)were independent risk factors for the incidence of dysphagia in patients with HH at 1 month after surgery.Compared with the preoperative period,the GERD-Q symptom scores were lower in both groups at 1 month,6 months,and 1 year postoperatively,and the difference was statistically significant(P<0.05);but there was no statistically significant difference between the groups at the same time point(Fintergroup=0.334,P=0.565).The difference between the two groups in 1-year postoperative recurrence rates was not statistically significant(P>0.05).Conclusions LHHR combined with Toupet or Dor fundoplication are both safe and effective surgical procedures for the treatment of HH,with excellent reflux control,fewer complications and lower recurrence rates,but Toupet fundoplication is more likely to have postoperative short-term dysphagia than Dor fundoplication.关键词
腹腔镜食管裂孔疝修补术/胃底折叠术/食管裂孔疝/术后疗效Key words
laparoscopic hiatal hernia repair/fundoplication/esophageal hiatal hernia/postoperative efficacy分类
医药卫生引用本文复制引用
梁胜昌,王金莲,郭怡斌,张琪,张宇鹏,曹廷宝,屈坤鹏..腹腔镜食管裂孔疝修补术联合Toupet或Dor胃底折叠术治疗食管裂孔疝的疗效分析[J].解放军医学杂志,2025,50(9):1122-1128,7.基金项目
This work was supported by the Natural Science Foundation of Gansu Province(23JRRA1384),and the Special Fund for Clinical Research of Wu Jie-Ping Medical Foundation(320.6750.16216) 甘肃省自然科学基金(23JRRA1384) （23JRRA1384）
吴阶平医学基金会临床科研专项基金(320.6750.16216) （320.6750.16216）
