腹腔镜Nissen胃底折叠术联合或不联合胃底膈固定术在食管裂孔疝外科治疗中的疗效评价。
Evaluation of Outcome of Laparoscopic Nissen Fundoplication with or without Fundophrenicopexia in Surgical Management of Hiatal Hernia.
文献信息
| PMID | 42869211 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Mahmoud Eissa |
| 作者单位 | Gastrointestinal Surgery Unit, Department of Surgery, Faculty of Medicine, Suez Canal University hospital, Egypt. |
| 期刊 | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 胃食管反流病（GERD）与食管裂孔疝常同时存在，损害生活质量并常需手术干预。腹腔镜Nissen胃底折叠术（LNF）是金标准，但复发、吞咽困难和胃胀气仍令人担忧。胃底膈固定术，即将胃底固定于膈肌，已被提出用于加强裂孔闭合并减少复发。本研究前瞻性比较了联合与不联合胃底膈固定术的LNF。
方法： 在苏伊士运河大学医院开展了一项前瞻性比较研究（2025年1月至2026年1月）。40例食管裂孔疝患者被纳入两组：单纯LNF组（n=20）和LNF联合胃底膈固定术组（n=20）。主要终点为疝复发，通过影像学或内镜定义。次要终点包括GERD-HRQL评分、手术参数、并发症、功能结局和再手术率。患者接受结构化临床和内镜评估随访。
结果： 在随访期间（11.2±1.8个月），单纯LNF组患者复发率为15%，而胃底膈固定术组为0%（p=0.04）。Logistic回归证实胃底膈固定术是独立保护因素（OR=0.18，95% CI：0.02-0.95）。LNF组的失败包括折叠包绕移位和破裂，而胃底膈固定术组的复发仅限于部分疝出。胃底膈固定术组手术时间更长（68.5分钟 vs 52.3分钟，p=0.003），但失血量和中转率相似。较大的疝尺寸和较高的BMI独立预测复发。生活质量结局有利于胃底膈固定术组，GERD-HRQL评分更低（中位数3 vs 6，p=0.042）且症状改善更大。
结论： 胃底膈固定术与较低的复发率和改善的患者报告结局相关，且未增加吞咽困难。这种改良可能增强耐久性和生活质量，特别是在大疝或BMI升高的患者中，并值得作为常规食管裂孔疝修补术的潜在辅助手段进一步评估。
英文摘要
BACKGROUND: Gastroesophageal reflux disease (GERD) and hiatal hernia frequently coexist, impairing quality of life and often requiring surgical intervention. Laparoscopic Nissen fundoplication (LNF) is the gold standard, but recurrence, dysphagia, and gas-bloat remain concerns. FundophrenicopexiaFundophrenicopexia, fixation of the gastric fundus to the diaphragm, has been proposed to reinforce hiatal closure and reduce recurrence. This study prospectively compared LNF with and without fundophrenicopexia.
METHODS: A prospective comparative study was conducted at Suez Canal University Hospitals (January 2025-January 2026). Forty patients with hiatal hernia were enrolled into two groups: LNF alone (n=20) and LNF with fundophrenicopexia (n=20). Primary endpoint was hernia recurrence, defined radiologically or endoscopically. Secondary endpoints included GERD-HRQL scores, operative parameters, complications, functional outcomes, and reoperation rates. Patients were followed with structured clinical and endoscopic assessments.
RESULTS: Recurrence occurred in 15% of patients undergoing LNF alone versus 0% with fundophrenicopexia (p=0.04)during the follow-up period (11.2±1.8months). Logistic regression confirmed fundophrenicopexiafundophrenicopexia as an independent protective factor (OR=0.18, 95% CI: 0.02-0.95). Failures in the LNF group included wrap migration and disruption, while recurrence in the fundophrenicopexiafundophrenicopexia group was limited to partial herniation. Operative time was longer with fundophrenicopexiafundophrenicopexia (68.5 vs 52.3minutes, p=0.003), but blood loss and conversion rates were similar. Larger hernia size and higher BMI independently predicted recurrence. Quality of life outcomes favored fundophrenicopexiafundophrenicopexia, with lower GERD-HRQL scores (median 3 vs 6, p=0.042) and greater symptom improvement.
CONCLUSION: Fundophrenicopexia was associated with lower recurrence and improved patient‑reported outcomes without increasing dysphagia. This modification may enhance durability and quality of life, particularly in patients with large hernias or elevated BMI, and warrants further evaluation as a potential adjunct in routine hiatal hernia repair.