行胃袖状切除术病人食管裂孔疝的诊治策略

Diagnosis and treatment strategy of hiatal hernia in patients undergoing sleeve gastrectomy

肥胖病人合并胃食管反流病和食管裂孔疝的比例较高。胃袖状切除术(SG)后可能增加或者缓解反流症状,手术中同时处理合并的食管裂孔疝是减少术后反流的重要措施,同时要做到胃袖状切除术的标准化。术前评估预测是否合并食管裂孔疝有时是比较困难的,术前胃食管反流病问卷、胃镜、上消化道造影、CT等可以提示术中是否需要进行探查。术中根据食管裂孔疝的解剖表现进行同期修补,根据需要决定是否使用补片。

The proportion of obese patients complicated with gastroesophageal reflux disease and hiatal hernia is relatively high.The reflux symptoms may aggravate or improve after sleeve gastrectomy(SG).Concurrent management of concomitant hiatal hernia during the operation is an important measure to reduce postoperative reflux,and the standardization of sleeve gastrectomy should be achieved.Preoperative evaluation and prediction of hiatal hernia are sometimes difficult.A preoperative gastroesophageal reflux disease questionnaire,gastroscopy,upper gastrointestinal imaging,and CT can indicate whether intraoperative exploration is necessary.Concurrent repair is performed at the same time according to the intraoperative anatomical manifestations of the hiatal hernia,and the application of patches is decided as needed.