先天性食管旁疝20例报告

Congenital Paraesophageal Hiatal Hernia , A Report of 20 Cases

为了回顾和评价先天性食管旁疝各种术式的治疗效果，总结近十余年中经手术治疗的食管旁疝２例。患儿男１５例，女５例，年龄３天～６．５岁。本组半数误诊为肺脓肿或其他疾病。治疗结果：２例行Ｂｅｌｓｅｙ术，均复发；１５例行Ｎｉｓｓｅｎ术，术后１例折叠过紧，１例并发回肠套叠，３例食管下段轻度狭窄，余１１例随访２～１０年，２例有折叠部分疝出；Ｔｈａｌ手术２例，近期效果好。由于该病易发生胃扭转或嵌顿，确诊后应立即手术。应注意防治Ｎｉｓｓｅｎ手术后发生折叠过紧及滑脱等并发症，Ｔｈａｌ术的近期疗效好。

A review of 20 cases (male 1 5 , female 5 , ranging in age from 3 days to 6 yrs and 5 mons ) with paraesophageal hiatal hernia treated surgically from June 1983 to June l995 are report- ed. of . them , 6 were misdiagnosed as lung abscess , 1 had severe anemia due to volvulus of the stomach , 1 associated with imperforate anus . The diagnosis was confirmed by plain chest film and barium meal exam. Two had a relapse after Belsey' s operation. Among the 15 cases of Nissen' s procedure , 1 complicated with ileal intussusception. The others have been followed-up for 2 ～1 0 yrs (mean , 5 yrs and 4 mons ) with satisfactory results , except 2 had a partial herniation of the wrap. The short-term outcome of 2 case. that underwent Thal's operation was good. One with stomach necrosis and liver ischemia was only performed on laparatomy. Because of volvulus or strangulation of the stomach , the patients should be operated on promptly. The main measures to prevent long-term complications of Nissenr's operation , such as tight , slipped and herniated fundoplication are discussed. The long-term efficacy of Thal' s method needs further observation.