1.中山大学附属第六医院 普通外科(疝和腹壁外科)，广东 广州 510655;2.广东省结直肠盆底疾病研究重点实验室，广东 广州 510655;3.广州市黄埔区中六生物医学创新研究院，广东 广州 510655
1.Department of General Surgery (Hernia and Abdominal Wall Surgery), the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China;2.Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, China;3.Guangzhou Zhongliu Biomedical Innovation Center, Guangzhou 510655, China
背景与目的 腹腔镜下食管裂孔疝（HH）补片修补术以创伤小、恢复快、并发症少等优势已成为治疗HH的主要手术方法。腹腔镜下的补片放置及固定技术仍然是一个难点。本研究介绍一种新式的HH补片放置方法并探讨其临床应用效果。方法 回顾性分析2019年1月—2020年12月中山大学附属第六医院疝和腹壁外科收治的120例行腹腔镜HH补片修补术患者的临床资料。入组患者均采用“对位对线”的补片放置方法。结果 全组患者的平均手术时间为（112±27）min，术后平均住院时间为（4.5±2.2）d，围手术期无死亡病例。手术后早期并发症包括吞咽困难7例，其中5例2周后缓解，2例手术后4周仍诉有吞咽困难，予以胃镜下行球囊扩张治疗后症状可缓解；手术后尿潴留2例，予以留置尿管对症处理后症状缓解；术后腹腔出血1例，予以急诊行腹腔镜探查止血；术后肠梗阻2例，予以保守治疗后痊愈。随访中位时间为26个月，其中14例（11.7%）失访。随访患者中有5例诉临床症状与手术前相比未得到明显改善，其余患者诉临床症状得到完全改善或部分改善。所有随访病例均无确切依据的解剖学复发。所有随访病例未发现补片相关并发症如补片移位、感染、补片侵蚀食管以及大血管等。结论 腹腔镜HH补片修补术中采用“对位对线”的补片放置方法是安全有效的，此方法操作简单容易实施，便于临床推广使用。
Background and Aims Laparoscopic hiatal hernia (HH) repair with mesh placement has become the primary surgical method for the treatment of HH due to its advantages of minimal trauma, rapid recovery, and fewer complications. However, the technique for mesh placement and fixation remains a challenge. This study was to introduce a novel method for HH mesh placement and explore its clinical application efficacy.Methods The clinical data of 120 patients who underwent laparoscopic HH repair at the Sixth Affiliated Hospital of Sun Yat-sen University from January 2019 to December 2020 were retrospectively analyzed. All patients included underwent mesh placement using the "contraposition and alignment" technique.Results The average operative time for the whole group of patients was (112±27) min, and the average length of postoperative hospital stay was (4.5±2.2) d. There were no deaths during the perioperative period. Early postoperative complications included dysphagia in 7 cases, with 5 cases achieving relief after 2 weeks and 2 cases still complaining swallowing difficulties at 4 weeks after operation, which were alleviated with gastroscopic balloon dilatation; postoperative urinary retention in 2 cases, which were relieved after symptomatic treatment with indwelling catheter; postoperative intra-abdominal bleeding in one case, which was managed with emergency laparoscopic exploration and hemostasis; postoperative bowel obstruction in 2 cases, which were cured with conservative treatment. The median follow-up time was 26 months, with 14 cases (11.7%) lost to follow-up. Among the followed-up patients, 5 cases complained clinical symptoms that did not significantly improve compared to preoperative conditions, while the rest of the patients reported complete or partial improvement in clinical symptoms. No cases of anatomical recurrence were observed in the followed-up patients. Furthermore, none of the followed-up cases experienced mesh-related complications such as mesh displacement, infection, and mesh erosion into the esophagus or major blood vessels.Conclusion The use of the "contraposition and alignment" technique for mesh placement in laparoscopic HH repair is safe and effective. This method is straightforward, easy to implement, and suitable for clinical promotion.