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目的 以食管动力学和胃食管反流评估食管裂孔疝 3种抗反流手术疗效。方法 41例食管裂孔疝中滑疝 15例、旁疝 3例、混合疝 2 3例。年龄 2个月～ 3岁 ,体重 5 .5～ 9 5kg。食管裂孔修补加Dor手术 2 8例 ,加Toupet手术 10例 ,仅做单纯裂孔修补 3例。全组进行了手术前、后食管动力及 2 4h食管pH监测。结果 术后随访 3～ 2 4个月 ,优良者 37例 (90 2 4% ) ,术后早期胃排空延迟 1例 (Toupet手术组 )GI示食管下段狭窄 5例 ,但有明显吞咽困难仅 1例 (未做胃底折叠术组 ) ,伤口裂开 1例 (Dor手术组 )。术后 3例仍有呕吐 (Dor手术组 ) ,3例复发 (2例Dor手术组 ,1例Toupet手术组 )。全组手术前后LESP改变不明显P >0 0 5 ,LESL术后明显增长 ,Dor手术组 (1 93± 0 6 1)cm ,Toupet手术组 (1 78± 0 44 )cm ,三组之间差异无显著性。旁疝混合疝组中用Dor手术修补术后LESL(2 13± 0 6 1)cm ,增长较Toupet手术修补更为显著 [(1 71± 0 49)cm ,P <0 0 5 ]。全组术后 2 4h食管pH监测参数明显改善 ,并以Toupet手术改善最显著。结论 三种抗反流手术均能有效减轻胃食管反流 ,以Toupet手术效果最佳。
Objective To evaluate the efficacy of three kinds of anti-reflux surgery for esophageal hiatal hernia by esophageal motility and gastroesophageal reflux. Methods 41 cases of esophageal hiatal hernia in 15 cases of sliding hernia, 3 cases of hernia, mixed hernia in 23 cases. Age 2 months to 3 years old, weight 5.5 ~ 9 5kg. 28 cases of esophageal hiatus repair plus Dor surgery, plus Toupet surgery in 10 cases, only simple repair of the hole in 3 cases. The whole group underwent preoperative and postoperative esophageal motility and 24 h esophageal pH monitoring. Results The patients were followed up for 3 ~ 24 months, 37 cases were excellent (90 2 4%), 1 case was postoperative delayed gastric emptying (Toupet operation). GI showed 5 cases of esophageal stricture, but had obvious dysphagia 1 case (no fundoplication group), 1 case of wound dehiscence (Dor group). There were still 3 cases of postoperative Vomiting (Dor surgery group), 3 cases of recurrence (2 cases of Dor surgery group, 1 case of Toupet surgery group). The changes of LESP before and after the operation in the whole group were not obvious (P> 0.05). The LESP in the Dor operation group (1 93 ± 0 6 1) cm, Toupet operation group (78 ± 0 44) cm, No significant. In the hernia group, LESL (2 13 ± 0 6 1) cm was repaired with Dor surgery, which was more significant than that of Toupet operation [(1 71 ± 0 49) cm, P 0 05). The parameters of esophageal pH monitoring at 24 hours after operation were significantly improved and the most significant improvement was seen with Toupet surgery. Conclusion All the three kinds of anti-reflux surgery can effectively reduce gastroesophageal reflux, and the best result is achieved by Toupet operation.