滑动型食管裂孔疝的外科治疗

Surgical treatment with sliding esophageal hiatal hernia

目的 探讨滑动型食管裂孔疝手术治疗的方法与效果。方法 对经X线钡餐及胃镜检查确诊的 5 2例滑动型食管裂孔疝并食管炎患者行手术治疗 ,其中Nissen手术 4 7例、Hill手术3例、Boerema手术 1例、Rampal手术 1例 ,于术前、术后进行 2 4h食管pH值和食管压力监测。以健康志愿者 30例为对照组 ,行 2 4h食管 pH值和食管压力监测。 结果 手术组患者术前均存在食管下括约肌的松弛和酸反流 ,术后则明显改善。 5 2例随访患者中疗效优者 33例 (6 3% )、良者 14例(2 7% )、欠佳者 3例 (2例吞咽困难、1例反流 ,占 6 % )、差者 2例 (2例复发 ,占 4 % )。结论 应完善术前检查及正确、严格掌握手术指征 ,以取得良好的手术疗效 ;术式以经腹短松式Nissen术为最佳。

Objective To study the effect and method of surgical treatment in patients with sliding esophageal hiatal hernia. Methods To divide into two groups: fifty two patients with sliding esophageal hiatal hernia diagnosed with gastroscopy and X ray barium meal examination accepted operation. Forty seven cases were treated by Nissen′s operation. Three cases were treated by Hill′s operation. One case was treated by Boerema's operation. One case was treated by Rampal′s operation. 24 hour esophageal pH and esophageal motility were also monitored before and after operation. Thirty healthy volunteer were performed control group and were monitored by 24 hour esophageal pH and esophageal motility. Results The patients in operation group had lower esophageal sphincter relaxation and acid reflux before operation. They became significantly ameliorative after operation. Forty seven cases (90%) had the satisfactory effect. Two cases (4%) recrudesced. Conclusion Comprehensive examination and perfect surgical choice may play an important role in the treatment of sliding esophageal hiatal hernia; The better method for sliding esophageal hiatal hernia is Nissen′s operation.