136例老年食管裂孔疝患者临床特征分析

Analysis of clinical characteristics about 136 cases patients with hiatal hernia in elderly

目的通过对老年食管裂孔疝(hiatus hernia,HH)患者的住院临床资料进行分析,探讨老年HH的临床特征,提高对疾病的认识。方法对1993年3月~2013年3月期间于北京大学第一医院住院的年龄≥65岁,确诊为HH患者进行回顾性分析,收集其性别、年龄、体重指数、确诊周期、主要临床症状、辅助检查方法及其阳性表现、诊断分型、合并症及误诊情况,并对不同检查方法的检出率进行比较。采用SPSS 19.0统计软件进行统计学分析。结果共136例患者入选本研究,年龄65~92岁,平均(75.2±6.6)岁,男65例,女71例(男∶女=1∶1.09)。52例患者(38.24%)体重指数(BMI)≥24 kg/m2。确诊周期为1 d^20余年。本组患者症状复杂多样,主要症状为反酸烧心(72例,52.94%)、腹痛(49例,36.03%)和恶心呕吐(43例,31.62%),各临床症状发生率无性别差异(P>0.05)。胸片检查120例,阳性29例(24.17%);上消化道造影67例,阳性61例(91.04%);胃镜80例,阳性72例(90.00%);胸/腹部CT 76例,阳性46例(60.53%)。上消化道造影、胃镜、CT检出率高于胸片(P<0.05);胃镜检出率高于CT(P<0.05);上消化道造影与胃镜、上消化道造影与CT的检出率差异无统计学意义(P>0.05)。115例患者分型明确,其中101例为Ⅰ型(87.83%),6例为Ⅱ型,1例为Ⅲ型,7例为Ⅳ型。共有115例接受上消化道造影和/或胃镜检查,其中64例检出合并胃食管反流病(GERD)(55.65%),男性组与女性组之间差异无统计学意义(P>0.05)。误诊12例(8.82%),分别被误诊为冠心病(8例),食管癌(2例),肺部占位(1例),胃溃疡(1例)。结论老年HH患病无明显性别差异,其症状复杂多样,病程长,确诊周期长;最主要症状为反酸烧心、腹痛及恶心呕吐,各症状发生率无明显性别差异;Ⅳ型HH最为常见;上消化道造影和胃镜检出率较高,不同检查方法各有利弊,可互相补充;老年患者HH症状不特异也不典型,容易造成误诊。

Objective To investigate the clinical characteristics of patients with hiatus hernia （HH） by analyzing the clinical data of elderly inpatients. Methods Inpatients admitted into Peking University First Hospital during March 1993 to March 2013 diagnosed as HH and elder than 65 were analyzed retrospectively. Gender, age, body mass index, diagnostic interval, main symptoms, auxiliary examination methods and manifestations, clinical subtypes, complications and misdiagnosis were collected and analyzed. The detection rates were compared between different modalities. SPSS 19.0 was used for statistical analysis. Results 136 patients were enrolled into the study. Aged from 65-92, the mean age was （75.2±6.6） years. 65 males and 71 females was 1：1.09. 52 patients （38.24%） were overweight or obese （BMI≥24 kg/m2）. The diagnostic interval varied from 1 day to more than 20 years. These patients had various clinical manifes-tations and their main symptoms were acid regurgitation and heartburn （72 cases, 52.94%）, abdominal pain （49 cases, 36.03%） and nausea and vomiting （43 cases, 31.62%）. There were no differences in the incidence of symptom between male and female （P〉0.05）. 29 cases （29/120, 24.17%） had positive chest X-ray results, and 61 cases （61/67, 91.04%） for upper gastrointestinal videofluorography, 72 cases （72/80, 90.00%） for EGD, 46 cases （46/76, 60.53%） for chest/ab-dominal CT scan. The detection rates of videofluorography, EGD and CT were superior to chest X-ray （P〈 0.05） and EGD superior to CT （P〈0.05）. There were no differences in the detection rates between videofluorography and EGD or CT （P〉 0.05）. Among the 115 patients who could be identified types, 101 cases were type Ⅰ （87.83%）, 6 cases were typeII, 1 case was typeⅢ, 7 cases were typeⅣ. 64 patients （64/115, 55.65%） who underwent videofluorography and/or EGD were complicated with GERD. There were no differences in the GERD between male and female （P〉0.05）. 12 patients （8.82%） were misdiagnosed, namely, coronary heart disease （8 cases）, esophageal cancer （2 cases）, lung mass （1 case） and gastric ulcer（1 case）. Conclusion The el-derly patients with HH have no gender difference. They have complicated various symptoms, long durations and diag-nostic intervals. Their main symptoms are acid regurgitation and heartburn, abdominal pain, nausea and vomiting and without gender difference in symptoms. The most common type is type Ⅰ. Videofluorography and EGD have higher de-tection rates but each modality possesses its own advantages and disadvantages, thus they can complement each other. The atypical and non-specific symptoms of elderly patients with HH result in high misdiagnosis rate.