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目的观察腹腔镜Toupet胃底折叠术对治疗老年食管裂孔疝合并胃食管反流病的临床疗效。方法 70例老年食管裂孔疝合并胃食管反流病患者,均在腹腔镜下行食管裂孔疝修补联合Toupet胃底折叠术治疗。观察术前和术后6个月患者食管反流情况、食管压力及并发症发生情况。结果术后6个月,患者24 h内反流时间短于术前,反流次数少于术前,胃食管反流病自测量表(GERDQ)评分低于术前,差异均具有统计学意义(P<0.05)。术后6个月,患者食管下括约肌压力和食管残余压均明显高于术前,松弛率及无效吞咽率明显低于术前,差异具有统计学意义(P<0.05)。患者术后6个月并发症发生相对较少,其中吞咽困难6例(8.6%),腹胀4例(5.7%),腹泻2例(2.9%),慢性疼痛3例(4.3%)。结论腹腔镜Toupet胃底折叠术可有效的提高老年食管裂孔疝合并胃食管反流病患者的临床治疗效果,值得临床推广运用。
Objective To observe the clinical efficacy of laparoscopic Toupet fundoplication for the treatment of senile hiatal hernia associated with gastroesophageal reflux disease. Methods Seventy patients with esophageal hiatal hernia and gastroesophageal reflux disease underwent laparoscopic esophageal hiatal hernia repair combined with Toupet fundoplication. Esophageal reflux, esophageal pressure and complications were observed before and 6 months after operation. Results At 6 months after operation, the time of reflux within 24 h was shorter than that before operation and the number of reflux was less than that before operation. The GERDQ score was lower than that before operation, and the difference was statistically significant (P <0.05). Six months after operation, the patients underwent esophageal sphincter pressure and esophageal residual pressure were significantly higher than preoperative, relaxation rate and invalid swallowing rate was significantly lower than preoperative, the difference was statistically significant (P <0.05). There were relatively fewer complications at 6 months after operation, with dysphagia in 6 (8.6%), bloating in 4 (5.7%), diarrhea in 2 (2.9%) and chronic pain in 3 (4.3%). Conclusions Laparoscopic Toupet fundoplication can effectively improve the clinical effect of esophageal hiatal hernia and gastroesophageal reflux disease in patients with geriatric esophageal reflux disease, which is worthy of clinical application.