食管裂孔疝再手术的难点与对策

Difficulties and countermeasures of reoperation for hiatal hernia

外科手术是治疗食管裂孔疝(HH)的最有效手段,但手术有一定的并发症发生率和复发率,尤其是使用补片后情况更加复杂。HH修补术后复发是其再手术的主要原因,根据原手术是否使用补片及术中探查的情况需要采取不同的对策,手术的难点是疝的回纳及折叠袢的拆除,手术的核心则在于确切关闭疝环及固定折叠袢,预防再次复发。补片相关并发症和其他严重并发症导致的再次手术个体差异较大,须根据具体情况而定。

Surgery is the most effective method for the treatment of hiatal hernia,however,there are certain complications and recurrence rates,especially after the use of mesh,the situation is more complicated.Recurrence after HH repair is the main reason for reoperation.Different strategies should be taken according to whether the mesh was used in the original operation and the situation of intraoperative exploration.The difficulty of the operation is the retraction of the hernia sac and the removal of the folded loop.The core of the operation is to accurately close the hernia ring and fix the folded loop to prevent recurrence.Reoperation due to mesh-related complications and other serious complications varies widely among individuals and often needs to be determined on a case-by-case basis.