探讨腹腔镜下手术与开腹手术治疗婴儿食管裂孔疝(EHH)患儿的临床疗效。

选择2017年1月至2023年9月于昆明市儿童医院采取手术治疗的46例EHH婴儿为研究对象。按照手术方法，将其分为开腹组(n＝22，采取开腹EHH修补术＋Nissen胃底折叠术)与腔镜组(n＝24，采取腹腔镜下EHH修补术＋Nissen胃底折叠术)。采用回顾性分析方法，收集2组患儿手术治疗情况及术后并发症发生率、EHH复发率等，并采用Mann-Whitney U检验与连续性校正χ²检验，或Fisher确切概率法进行统计学分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》相关要求。患儿监护人对诊疗均知情同意，并签署临床研究知情同意书。

对46例患儿均成功完成手术，无一例患儿死亡。腔镜组患儿手术中位时间为192.0 min(112.5 min，243.8 min)，显著长于开腹组的97.5 min(81.0 min，120.0 min)，术后开始经口进食中位时间为2.0 d(2.0 d，4.0 d)，较开腹组的4.0 d(3.0 d，4.0 d)短，并且差异均有统计学意义(Z＝－3.59，P<0.001；Z＝－2.39，P＝0.017)。2组患儿术中出血量及术后住院时间比较，差异均无统计学意义(P>0.05)。腔镜组术后，5例(20.8%)患儿发生EHH复发，术后并发症包括腹胀为1例(4.2%)，呕吐为4例(16.7%)，胃食管反流(GER)为3例(12.5%)，消化道出血为2例(8.3%)；再次手术修复EHH为1例(4.2%)。开腹组患儿术后腹胀、GER发生率均为4.5%(1/22)。2组患儿术后复发率与腹胀、呕吐、GER、消化道出血等并发症发生率和再手术率分别比较，差异均无统计学意义(P>0.05)。对42例患儿随访的平均时间为27.6个月(1～83个月)。随访过程中，开腹组1例患儿长期存在反酸、胸痛等GER症状；腔镜组术后5例EHH复发，其中4例通过保守治疗好转，1例因保守治疗效果不佳，经再次腹腔镜下EHH修补术后治愈。

腹腔镜下EHH修补术＋Nissen胃底折叠术，以及开腹EHH修补术＋Nissen胃底折叠术，均可有效治疗婴儿EHH。与开腹EHH修补术＋Nissen胃底折叠术相比，腹腔镜下EHH修补术＋Nissen胃底折叠术对患儿具有术后开始经口进食时间早、切口小、美观等优点。

To analyze the clinical efficacy between laparoscopic surgery and open surgery for treating infantrle esophageal hiatal hernia (EHH).

A total of 46 infants with EHH who underwent surgical treatment at Kunming Children′s Hospital from January 2017 to September 2023 were selected as research subjects. Patients were divided into two groups based on the surgical method: the open surgery group (n=22, received open surgery for EHH repair and Nissen fundoplication) and the laparoscopic group (n=24, received laparoscopic surgery for EHH repair and Nissen fundoplication). The surgical treatment, incidence of postoperative complications and EHH recurrence of two groups were collected by retrospective analysis method, and were compared Mann-Whitney U test, continuity-corrected chi-square test, or Fisher′s exact test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013. Guardians of the patients were informed and consented to the diagnosis and treatment, and they signed informed consent forms for clinical research.

All 46 cases underwent successful surgery without any fatalities. The laparoscopic group had a longer surgical duration compared to the open surgery group [192.0 min (112.5 min, 243.8 min) vs 97.5 min (81.0 min, 120.0 min), Z=-3.59, P<0.001]. Time to oral intake post-operation was shorter in the laparoscopic group compared to the open surgery group [2.0 d (2.0 d, 4.0 d) vs 4.0 d (3.0 d, 4.0 d), Z=-2.39, P=0.017]. There was no statistically significant difference between the two groups in terms of intraoperative blood loss or length of hospital stay (P>0.05). Postoperative complications in the laparoscopic group included recurrence in 5 cases (20.8%), abdominal distension in 1 case (4.2%), vomiting in 4 cases (16.7%), gastroesophageal reflux (GER) in 3 cases (12.5%), gastrointestinal bleeding in 2 cases (8.3%), and 1 case (4.2%) requiring reoperation. In the open surgery group, postoperative complications included abdominal distension in 1 case (4.5%) and GER in 1 case (4.5%). There was no statistically significant difference between the two groups regarding recurrence, incidences of abdominal distension, vomiting, GER, gastrointestinal bleeding, or rate of need for reoperation (P>0.05). Out of 42 followed-up cases with an average follow-up duration of 27.6 months post-operation (ranging from 1 to 83 months), vomiting symptoms disappeared, and normal growth and development were observed. One case in the open surgery group experienced long-term symptoms of GER such as acid regurgitation and chest pain. In the laparoscopic group, 5 cases experienced recurrence post-operation, with 4 cases showing improvement through conservative treatment and 1 case achieving cure after laparoscopic re-repair due to ineffective conservative treatment.

Both laparoscopic surgery for EHH repair and Nissen fundoplication, and open surgery for EHH repair and Nissen fundoplication can effectively treat infantile EHH. Compared to open surgery, laparoscopic repair of EHH and Nissen fundoplication demonstrates advantages such as an earlier start of oral intake post-operation, smaller incisions, and improved aesthetic outcomes.