短食管型食管裂孔疝临床特点及疗效分析

Clinical characteristics and efficacy analysis of short esophageal hiatal hernia

目的探究短食管型食管裂孔疝(SEHH)的临床特点及食管裂孔疝修补术联合Nissen胃底折叠术治疗SEHH的安全性和有效性。方法收集2023年10月至2024年4月,新疆维吾尔自治区人民医院收治的8例SEHH患者的临床资料、术前检查结果、术中及术后情况、随访情况等,分析SEHH的临床特点及手术疗效。结果8例患者中,男性5例,女性3例。年龄(59.5±9.0)岁,体重指数(30.0±2.53)kg/m^(2),血红蛋白64~140 g/L,平均(90±27)g/L,7例患者合并贫血。所有患者上消化道造影检查均提示有SEHH,胸腹部CT提示疝囊容积373(262~537)cm3、食管裂孔横径(4.4±0.53)cm,胃食管反流病问卷量表(Gerd Q)评分(10.6±1.92)分,高分辨率食管测压(HREM)提示食管裂孔疝直径(6.8±1.80)cm,DeMeester评分32.8(15.2~50.6)分,食管长度系数18.3±0.67。术中测量胃食管结合部与食管裂孔的距离为(2.5±0.16)cm。8例均行HHR联合Nissen胃底折叠术,3例采用机器人手术,5例为腹腔镜手术。其中2例联合行胆囊切除术,1例联合行切口疝修补术。手术时长(173±79)min,术中出血20~150 ml,术后住院时间3~13 d。8例SEHH患者均顺利出院,术后随访4~10个月,所有患者反酸、烧心症状均消失,未发生吞咽困难,未见食管裂孔疝(HH)复发。结论SEHH患者临床症状与HH患者类似,并且大部分合并贫血。腹腔镜或机器人辅助食管裂孔疝修补术+Nissen胃底折叠术治疗SEHH均安全有效,短期随访效果良好。

Objective To investigate the clinical characteristics of short esophageal hiatal hernia(SEHH)and the safety and efficacy of hiatal hernia repair combined with Nissen fundoplication for the treatment of SEHH.Methods Clinical data,preoperative examination results,intraoperative and postoperative conditions,follow-up information of 8 SEHH patients admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from October 2023 to April 2024 were collected.The clinical characteristics and the safety and surgical effect for SEHH were analyzed.Results Among the 8 patients,there were 5 males and 3 females.Age(59.5±9.0)years,body mass index(30.0±2.53)kg/m^(2),hemoglobin(64-140)g/L,mean(90±27)g/L,7 patients had anemia.All patients showed SEHH on upper gastrointestinal imaging.CT showed a hernia sac volume of 373(262-537)cm3,a transverse diameter of the hiatus of(4.4±0.53)cm,a Gastroesophageal reflux disease questionnaire(Gerd Q)score of(10.6±1.92)points,high resolution esophageal manometry(HREM)indicating a hiatus hernia diameter of(6.8±1.80)cm,a DeMeester score of 32.8(15.2-50.6)points,and an esophageal length coefficient of 18.3±0.67.Intraoperative measurements revealed that the distance between the gastroesophageal junction and the hiatus is(2.5±0.16)cm.All 8 patients underwent HHR combined with Nissen fundoplication,with 3 cases performed by robots and 5 cases performed by laparoscopy.Two cases underwent combined cholecystectomy,and one case underwent combined incisional hernia repair.The surgical duration was(173±79)minutes,intraoperative bleeding was 20-150 ml,and postoperative hospital stay was 3-13 days.All 8 patients with SEHH were successfully discharged and followed up for 4-10 months after surgery.The symptoms of acid reflux and heartburn disappeared in all patients,and dysphagia did not occur.No recurrence of hiatal hernia(HH)was observed.Conclusion The clinical symptoms of patients with SEHH are similar to those of patients with HH,and most of them are accompanied by anemia.Laparoscopic or robot assisted hiatal hernia repair with Nissen fundoplication is safe and effective treatment for SEHH,with good short-term follow-up results.