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首页> 外文期刊>Surgical Endoscopy >Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability.
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Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability.

机译：腹腔镜大食管裂孔疝修补术：生活质量和耐用性。

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BACKGROUND: Laparoscopic repair of large paraesophageal hiatus hernias (LPOHH) is shown to be a safe and effective operation in the short term. However, its long-term durability and its effect on quality of life are less well established. This study aimed to assess the midterm outcome for laparoscopic repair of LPOHH with validated quality-of-life symptom scores and barium studies. METHODS: Between January 2000 and July 2004, 49 patients (27 women) with LPOHH underwent laparoscopic repair. The median age of these patients was 68 years (range, 38-90 years). The laparoscopic repair included resection of the hernia sac, reduction of its contents, esophageal mobilization up to the aortic arch, crural repair with sutures (mesh reinforcement in 17 cases), Nissen fundoplication, and fixation of the wrap to the crura. Follow-up assessment was prospective with quality-of-life questionnaires, the Gastrointestinal Symptom Rating Scale (GSRS), the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) scale, and barium studies. RESULTS: The presenting symptoms were pain for 21 patients, reflux for 27 patients, bleeding or anemia for 14 patients, and dysphagia for 17 patients. Five emergency operations were performed. Short esophagus was present in 24 patients. There were two conversions to open surgery. The major morbidity (atrial fibrillation, pulmonary embolism, and splenectomy) rate was 10.2%, and the minor morbidity (chest infection, jaundice, dysphagia, small pneumothorax) rate was 20.4%. Six patients were deceased of unrelated causes at the time of follow-up evaluation. Responses to the questionnaires were obtained in 31 cases (75%). Using the Wilcoxon signed rank test, the results from the questionnaires showed a statistically significant improvement (p < 0.001) in abdominal pain, reflux, and indigestion scores (GSRS) and GERD-HRQOL scores. Follow-up barium studies for 27 patients (66%) showed recurrence in 4 patients (14.8%), 2 of which were symptomatic. CONCLUSION: Laparoscopic repairof LPOHH is associated with good quality of life as well as an acceptable midterm recurrence rate.
机译：背景：腹腔镜修补大食管旁裂孔疝（LPOHH）在短期内被证明是安全有效的手术。但是，其长期耐用性及其对生活质量的影响尚不明确。这项研究旨在通过验证的生活质量症状评分和钡剂研究评估腹腔镜LPOHH修复的中期结果。方法：2000年1月至2004年7月，对49例LPOHH患者（27例女性）进行了腹腔镜修复。这些患者的中位年龄为68岁（范围38-90岁）。腹腔镜修复包括切除疝囊，减少其内容，食道动员至主动脉弓，使用缝合线进行结扎修复（17例筛网加固），尼森胃底折叠术以及将包裹物固定在结直肠上。随访评估通过生活质量问卷，胃肠道症状评定量表（GSRS），胃食管反流病-健康相关生活质量（GERD-HRQOL）量表和钡剂研究进行前瞻性评估。结果：表现症状为疼痛21例，反流27例，出血或贫血14例，吞咽困难17例。进行了五次紧急行动。 24例患者出现食管短。有两次转换为开放手术。主要发病率（房颤，肺栓塞和脾切除术）率为10.2％，次要发病率（胸部感染，黄疸，吞咽困难，小气胸）为20.4％。随访评估时有6例患者死于无关原因。 31例（75％）获得了对问卷的回应。使用Wilcoxon符号等级检验，问卷调查的结果显示，腹痛，反流和消化不良评分（GSRS）和GERD-HRQOL评分具有统计学上的显着改善（p <0.001）。对27例患者（66％）进行的后续钡剂研究显示4例患者（14.8％）复发，其中2例是有症状的。结论：腹腔镜修补LPOHH与良好的生活质量以及可接受的中期复发率有关。

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