摘要
食管裂孔疝即腹腔内脏器经食管裂孔疝入胸腔,并引发烧心、反酸等消化道及其他非消化道症状。按其解剖及临床表现可分为四型。通过病史采集、体格检查及一系列客观检查可以明确食管裂孔疝的诊断、分型及疾病进展程度。食管裂孔滑动疝并发反流、食管裂孔旁疝合并明显症状、混合型及多器官型食管裂孔疝或内科治疗效果不佳的通常应优先考虑手术治疗,以消除疝形成的因素,控制胃食管反流。食管裂孔疝手术目前通常采取腹腔镜下疝修补、补片加强及胃底折叠术,同时也存在食管延长、胃固定等其他替代术式。围手术期通过积极地控制风险因素,有助于降低各类术中、术后并发症风险及复发率。对复发、儿童及肥胖等特殊患者,也应视患者条件积极实施手术治疗。随着研究的进一步深入,食管裂孔疝手术在手术入路、补片材料、复发及并发症控制、日间手术模式应用等方面将取得更大的进展。
Hiatus hernia （HH）, namely the abdominal organs into the chest through the esophageal hiatus, resulting in heartburn, acid reflux and other gastrointestinal and non-gastrointestinal symptoms. HH can be diagnosised and divided into four types, by history, physical examination and a series of examination. The cases which is type I （sliding hiatus hernia） with reflux, type Ⅱ （paraesophageal hiatal hernia） complicated with obvious symptoms, type Ⅲ ~ Ⅳ or poor treatment through internal medicine usually need operation treatment, to eliminate the formative factors of HH, and to control symptoms of gastroesophageal reflux. HH can be effectively repaired by laparoscopic approach, the use of mesh for reinforcement, and a fundoplication, but sometimes gastroplasty and gastropexy may be needed as an alternative operation. The risk factors of perioperation should be controlled to reduce the rate of perioperation complication and recurrence. The patients with recurrence or obesity, children and other special patients, also need the operation when necessary. With further study, hiatal hernia operation will achieve greater progress in the aspects of operative approach, mesh material, recurrence and complications control, and the model of ambulatory surgery.
出处
《医学与哲学（B）》
2014年第6期47-51,共5页
Medicine & Philosophy(B)
关键词
食管裂孔疝
外科治疗
研究进展
hiatal hernia, surgical treatment, study progress
