小儿先天性食管裂孔疝的外科治疗方法探讨

Surgery for congenital hiatus hernia in children:A treatment of choice

目的食管裂孔疝在各类膈疝中最为常见。文中通过37例小儿食管裂孔疝手术治疗的临床资料回顾性分析，探讨小儿食管裂孔疝的诊断及手术方法与疗效的关系。方法2003年1月至2007年5月手术治疗食管裂孔疝37例，其中男22例，女15例，年龄2月-13岁，平均（17．0±26．8）个月；体重3．8～39．5kg，平均（9．35±6．02）k。根据上消化道钡餐检查明确诊断：其中滑疝15例（40．5％），食管旁疝11例（29．7％），混合型疝8例（21．6％），巨大型疝3例（8．1％）；合并短食管3例（8．1％）。大部分患儿均有不同程度贫血，血红蛋白31—134g／L，平均（97±26）g／L。合上消化道出血11例（29．7％），肺炎5例（13．5％）。37例患者共行手术40例次，其中术后复发1次和2次各1例。经腹手术32例次，经胸手术8例次。手术除常规行食管裂孔疝修补外，加行胃底折叠术17例次，胃小弯固定术（Boerema术）17例次，胃底折叠＋胃小弯固定术6例次。结果全组无手术死亡，术后随访2～6年，2例复发，其余患儿术前症状消失，体重增加，生长发育良好。结论对有症状的食管裂孔疝应积极手术治疗，食管裂孔修补结合不同的抗反流手术具有良好的效果。

Objective This study aimed to explore the diagnosis and treatment of congenital hiatus hernia in children and the relationship between surgical approaches and treatment results by retrospective analysis of the clinical data of 37 surgically treated patients. Methods Thirty-seven children with congenital hiatus hernia underwent surgical treatment from January 2003 to May 2007. They were 22 males and 15 females, aged from 2 months to 13 years with a mean of （ 17.0 ±26.8） months. Their body weight ranged from 3.8 to 39.5 kg, averaging （9.35 ±6.02） kg. The patients were diagnosed by barium meal examination, 15 （40.5%） as having sliding hernia, 11 （29.7%） paraesophageal hernia, 8 （21.6%） mixed-type hernia and 3 （8.1%） macrosis hernia. Three of the cases （8.1% ） were complicated by short esophagus, 11 （29.7%） by upper gastrointestinal tract bleeding, and 5 （13.5%） by pneumonia. Most of them had anemia, with hemoglobin ranging from 31 to 134 g/L, averaging （97 ± 26 ） g/L. Forty operations were performed on the 37 patients because of a recurrence in one case and two in another. All the patients underwent esophageal hiatus repair concomitantly with anti-reflux procedures including fundoplication in 17, Boerema in 17 and fundoplication plus Boerema in 6 operations. Results None of the patients died of surgery. During the 2 - 6 years foflow-up, 2 cases experi-enced recurrence, while all the others remained symptom-free, well developed, with body weight increased. Conclusion Surgery is a treatment of choice for congenital hiatus hernia. And esophageal hiatus repair performed concomitantly with a specific anti-reflux proce- dure would add to the effectiveness.