食管裂孔疝及胃食管反流病规范化腹腔镜手术七步法操作指南（2025版）

Laparoscopic standardized seven-step surgical operative guidelines for hiatal hernia and gastroesophageal reflux disease (2025 edition)

摘要:

本指南在《食管裂孔疝及胃食管反流性疾病腹腔镜下规范化七步法手术操作指南（2021版）》基础上，更新了近4年的循证医学证据，旨在为胃食管反流病和食管裂孔疝的外科治疗提供标准化和同质化的指导。指南详细阐述了术前检查、手术适应证、禁忌证、术前准备、手术操作步骤、术后处理及随访等内容。手术操作采用七步法，包括放置穿刺套管、探查腹腔、游离腹段食管、关闭食管裂孔缺损、加强膈肌脚和固定补片、构建抗反流结构、冲洗创面及关闭穿刺孔。指南强调了术前多学科评估、个体化手术方案选择及术后并发症管理的重要性，旨在提高手术的安全性和有效性，减少术后并发症，改善患者生活质量。

Abstract:

Based on the "Laparoscopic standardized seven-step surgical procedure guidelines for hiatal hernia and gastroesophageal reflux disease (GERD) (2021 edition)", this guideline updates the evidence-based evidence from the past four years. It aims to provide standardized and homogenized guidance for the surgical treatment of GERD and hiatal hernia. The guideline elaborates on preoperative examination, surgical indications, contraindications, preoperative preparation, surgical steps, postoperative management, and follow-up. The surgical procedure follows a seven-step approach, which includes placement of trocars, abdominal cavity exploration, mobilization of the abdominal esophagus, closure of the hiatal defect, reinforcement of the diaphragmatic crura with mesh fixation, construction of the anti-reflux valve mechanism, irrigation of the operative field and closure of port sites. The guideline emphasizes the importance of preoperative multidisciplinary evaluation, individualized surgical planning, and management of postoperative complications, aiming to enhance the safety and effectiveness of surgery, reduce postoperative complications, and improve the patient's quality of life.