食管裂孔疝误诊为冠心病32例

The clinical analysis of esophageal hiatal hernia misdiagnosed as coronary heart disease in 32 cases

目的探讨症状酷似冠心病的食管裂孔疝的临床特点,以减少该病误诊或漏诊的发生。方法对2000年1月至2013年12月,北京市普仁医院诊断的伴有胸痛的食管裂孔疝32例患者的临床表现、诱因与缓解方法、心电图表现等方面进行分析,食管裂孔疝的诊断采用电子胃镜检查及X线上消化道造影二种方法。结果 32例患者的首先给予药物治疗以抑酸剂促进食管、胃排空药物等。24例患者症状明显缓解,好转出院。8例患者上述药物治疗效果失败转外科手术治疗。结论食管裂孔疝的症状与冠心病相似,对于中老年胸痛患者,除了考虑冠心病以外,应及时行X线检查或胃镜检查,可提高食管裂孔疝的检出率,以减少误诊和漏诊的发生。

Objective To explore the clinical characteristics of esophageal hiatal hernia similar to coronary heart disease, in order to reduce the misdiagnosis or missed diagnosis of hiatal hernia. Methods From January 2000 to December 2013, 32 cases of who presented a chest pain were diagnosed as hiatal hernia in our hospital. The clinical manifestations, causes and mitigation methods, ECG, and etc. were analyzed. Hiatal hernia was diagnosed by two methods： electronic gastroscopy and X-ray upper gastrointestinal contrast. Results The patients initially received drug treatment, such as antacids and drugs for promoting esophageal, gastric emptying. 24 patients were improved and then discharged from hospital. While, 8 conversions to surgical treatment were necessary due to failure of drug treatment. Conclusions Esophageal hiatus hernia may have similar symptoms with coronary heart disease. For aged patients with chest pain, in addition to the consideration of coronary heart disease, we should give X ray or gastmscopy examination in time, to improve the detection rate and to reduce the misdiagnosis and missed diagnosis of hiatal hernia.