2种食管裂孔疝手术入路方式的临床疗效对比

Comparison of Clinical Effects of Two Surgical Approaches for Esophageal Hiatal Hernia

摘要: 目的：对比2种食管裂孔疝手术入路的疗效及安全性。方法：将32例保守治疗效果不佳的食管裂孔疝病人按手术入路分为经胸入路组15例与经腹入路17例。观察并记录术中出血量、术后引流量及术后住院时间等；同时使用VAS，即视觉模拟评分法(0~10分，患者得分越高表明疼痛越剧烈)来观察比较术后患者的疼痛情况，并且对所有病例进行3个月的近期追踪随访。结果：所有病人手术均成功，经胸入路组发生3例肺部感染，2例功能性胃瘫，保守治疗出院。在手术时间和住院期间总花费方面相比，2组病例的差异没有统计学意义(p > 0.05)；而2组病例手术出血量、手术后引流量、手术后住院天数及手术后并发症发生率比较，差异均具有统计学意义(p < 0.05)。经腹入路组患者手术疼痛VAS评分低于经胸入路组，差异具有统计学意义(p < 0.05)。随访三个月，主诉未见明显的不适感，临床症状得到了有效减轻。结论：2种手术方法在食管裂孔疝治疗中的安全性以及有效性均能得到保证，近期随访疗效较好。经腹入路具有手术后并发症发生率较低、手术后住院时间较短、手术后引流量较少、手术出血量较少、术后疼痛VAS评分低的优点。

Abstract: Objective: Comparing the benefits and risks of transthoracic versus transabdominal approaches to paraesophageal hernia surgery. Methods: An analysis of 32 hiatal hernia patients with failed con-servative treatment was performed by dividing them into groups based on their transthoracic and transabdominal approaches. A three-month follow-up was done on all cases to determine the in-traoperative blood loss, postoperative drainage volume, and hospital stay. The visual analogue scale (VAS) (0~10 points, with higher scores indicating more severe pain) was used to observe and com-pare the postoperative pain of patients. Results: All patients underwent successful operations. In transthoracic approach group, 3 cases of pulmonary infection and 2 cases of functional gastropare-sis occurred, and they were discharged after conservative treatment. The operation times and hos-pitalization costs of the two groups were not significantly different (p > 0.05); In terms of surgical blood loss, drainage, postoperative hospital stay, and complications following surgery, statistically significant differences were observed among the two groups (p < 0.05). The VAS score of surgical pain in the transabdominal approach group was lower than that in the transthoracic approach group, and the difference was statistically significant (p < 0.05). During the 3-month follow-up, there was no obvious discomfort, and the clinical symptoms were effectively relieved. Conclusion: The safety and effectiveness of the two surgical methods in the treatment of hiatal hernia can be guar-anteed, with good short-term follow-up results. The transabdominal approach has advantages in the incidence of postoperative complications, postoperative hospital stay, postoperative drainage vol-ume, intraoperative blood loss and lower postoperative pain VAS score.