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目的通过探讨腹腔镜治疗小儿食道裂孔疝的优缺点、小儿食道裂孔疝手术时机的把握以及腹腔镜手术安全性等问题,为临床广泛推广应用腹腔镜治疗小儿食管裂孔疝提供一定的帮助。方法回顾性分析2012年10月~2016年12月4个小儿外科诊疗中心(新疆维吾尔自治区人民医院小儿外科、首都儿科研究所小儿外科、华中科技大学同济医学院附属协和医院小儿外科、河北医科大学附属第二医院小儿外科)收治的55例经腹腔腹腔镜手术治疗的食管裂孔疝患者的病历资料;分析经腹腔腹腔镜治疗小儿食管裂孔疝的手术指针、手术要点以及手术安全性。结果 55例食道裂孔疝患儿腹腔镜下手术一次成功54例,一例术后2月复查发现食管裂孔疝复发,再次行经腹腔腹腔镜下食管裂孔疝补片修补+疝囊切除术,术后随访半年未再次复发。经腹腔腹腔镜手术时间为120~180 min,术中均无明显的失血;术后24~48 h进食流质饮食;不切除疝囊的患儿,疝囊较大者术后复查胸片可见胸部局部有阴影,疝囊小者无明显阴影。结论小儿食管裂孔疝经腹腔腹腔镜手术治疗可以在有腹腔镜操作经验的小儿外科专科医师中进一步推广应用。
Objective To explore the advantages and disadvantages of laparoscopic treatment of children with esophageal hiatal hernia, grasps the timing of pediatric esophageal hiatal hernia and the safety of laparoscopic surgery and so on, and provides some help for the popularization and application of laparoscopic treatment of hiatal hernia in children. Methods A retrospective analysis was performed on four pediatric surgical centers (Pediatric Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Pediatric Surgery, Capital Institute of Pediatrics, Pediatric Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hebei Medical University Second Affiliated Hospital of Pediatric Surgery) admitted to 55 cases of laparoscopic transabdominal laparoscopic treatment of esophageal hiatal hernia patient’s medical records; analysis of transabdominal laparoscopic surgical treatment of pediatric hippocampal hiatal hernia surgery guidelines, the main points of surgery and surgical safety. Results In 55 cases of hiatal hernia with hiatal laparoscopic surgery, 54 cases were successfully treated by laparoscopy. One case was retrospectively reviewed in February and found to be recurrent esophageal hiatal hernia. The patients underwent retroperitoneal laparoscopic esophageal hernia repair and hernia resection. The patients were followed up Six months did not relapse again. Laparoscopic laparoscopic surgery time was 120 ~ 180 min, no significant intraoperative blood loss; 24 ~ 48 h after eating liquid diet; children without removal of hernia sac, the greater the hernia sac after chest X-ray examination Local shadow, no significant shadow hernia capsule. Conclusion Pediatric esophageal hiatal hernia by abdominal laparoscopic surgery in pediatric surgery specialist with experience in laparoscopic surgery to further promote the use.