BACKGROUND Giant paraesophageal hiatal hernias (HH) are very infrequent,and their spectrum of clinical manifestations is large.Giant HH mainly occurs in elderly patients,and its relationship with anemia has been repor...BACKGROUND Giant paraesophageal hiatal hernias (HH) are very infrequent,and their spectrum of clinical manifestations is large.Giant HH mainly occurs in elderly patients,and its relationship with anemia has been reported.For the surgical treatment of large HH,Nissen fundoplication is the most common antireflux procedure,and the reinforcement of HH repair with a patch (either synthetic or biologic) is still debatable.CASE SUMMARY We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia.After performing a series of tests and diagnostic approaches,results showed a complete intrathoradc stomach associated with severe iron deficiency anemia.The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication.Postoperatively,reflux symptoms were markedly relieved,and the imaging study showed complete reduction of the hernia sac.More importantly,anemia was resolved,and hemoglobin,serum iron and ferritin level were returned to the normal range.The patient kept regular follow-up appointments and remained in a satisfactory condition.CONCLUSION This case report highlights the relationship between large HH and iron deficiency anemia.For the surgical treatment of large HH,laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.展开更多
目的探讨8-羟基脱氧鸟苷(8-OHdG)以及炎症因子在胃食管反流病(GERD)合并心房颤动(AF)患者食管黏膜中的表达及其在AF发生中的意义。方法按照纳入、排除标准选取2017年1月至2018年11月间在新疆维吾尔自治区人民医院收治的90例患者设为研...目的探讨8-羟基脱氧鸟苷(8-OHdG)以及炎症因子在胃食管反流病(GERD)合并心房颤动(AF)患者食管黏膜中的表达及其在AF发生中的意义。方法按照纳入、排除标准选取2017年1月至2018年11月间在新疆维吾尔自治区人民医院收治的90例患者设为研究组。同期完成体检的23例健康受试者设为对照组。研究组均行24 h动态心电图、24 h pH值监测、高分辨率食管测压监测并内镜下取食管齿状线上3 cm处的局部黏膜作为标本,后续采用HE染色、免疫组化、RT-PCR、ELISA等方法分析组织炎症程度、氧化损伤标记物8-OHdG及炎症因子[单核细胞趋化蛋白1(MCP-1)、白细胞介素(IL)-8、肿瘤坏死因子(TNF)-α]的表达及血清浓度。结果根据患者的临床表现,内镜及24 h动态心电图检查,将其分为GERD合并AF组(AF组)、GERD不合并AF组(非AF组)和对照组。食管24 h pH监测比较显示,AF组弱酸反流(40.05)。光镜下观察发现,对照组黏膜组织形态基本完整,未见水肿或中性粒细胞等免疫细胞的浸润;非AF组可见中度中性粒细胞的浸润和炎症反应;而AF组食管黏膜组织出现不同程度的中性粒细胞,嗜酸性粒细胞等免疫细胞的浸润、乳头延长、水肿等炎症性改变。AF组炎症评分达到高峰,并显著高于非AF组(P<0.01)。免疫组化结果发现,对照组8-OHdG主要表达在食管上皮层、黏膜及黏膜下层,而AF组8-OHdG的表达几乎覆盖全层黏膜,表示严重的组织氧化损伤。RT-PCR和ELISA实验发现,与对照组相比,8-OHdG、MCP-1、IL-8、TNF-α的mRNA相对表达量以及其血清浓度,在非AF组和AF组中明显上升,且AF组中达到高峰,三组之间差异具有统计学意义(P<0.01)。Pearson相关性分析得出,AF组中8-OHdG血清浓度分别与Demeester评分及MCP-1、IL-8、TNF-α血清浓度之间具有正相关关系(P<0.01)。结论 8-OHdG以及炎症因子(MCP-1、IL-8、TNF-α)在GERD合并AF患者食管黏膜的表达及血清浓度显著增高,可能与酸反流诱发AF的产生密切相关。展开更多
文摘BACKGROUND Giant paraesophageal hiatal hernias (HH) are very infrequent,and their spectrum of clinical manifestations is large.Giant HH mainly occurs in elderly patients,and its relationship with anemia has been reported.For the surgical treatment of large HH,Nissen fundoplication is the most common antireflux procedure,and the reinforcement of HH repair with a patch (either synthetic or biologic) is still debatable.CASE SUMMARY We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia.After performing a series of tests and diagnostic approaches,results showed a complete intrathoradc stomach associated with severe iron deficiency anemia.The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication.Postoperatively,reflux symptoms were markedly relieved,and the imaging study showed complete reduction of the hernia sac.More importantly,anemia was resolved,and hemoglobin,serum iron and ferritin level were returned to the normal range.The patient kept regular follow-up appointments and remained in a satisfactory condition.CONCLUSION This case report highlights the relationship between large HH and iron deficiency anemia.For the surgical treatment of large HH,laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.
文摘目的探讨8-羟基脱氧鸟苷(8-OHdG)以及炎症因子在胃食管反流病(GERD)合并心房颤动(AF)患者食管黏膜中的表达及其在AF发生中的意义。方法按照纳入、排除标准选取2017年1月至2018年11月间在新疆维吾尔自治区人民医院收治的90例患者设为研究组。同期完成体检的23例健康受试者设为对照组。研究组均行24 h动态心电图、24 h pH值监测、高分辨率食管测压监测并内镜下取食管齿状线上3 cm处的局部黏膜作为标本,后续采用HE染色、免疫组化、RT-PCR、ELISA等方法分析组织炎症程度、氧化损伤标记物8-OHdG及炎症因子[单核细胞趋化蛋白1(MCP-1)、白细胞介素(IL)-8、肿瘤坏死因子(TNF)-α]的表达及血清浓度。结果根据患者的临床表现,内镜及24 h动态心电图检查,将其分为GERD合并AF组(AF组)、GERD不合并AF组(非AF组)和对照组。食管24 h pH监测比较显示,AF组弱酸反流(40.05)。光镜下观察发现,对照组黏膜组织形态基本完整,未见水肿或中性粒细胞等免疫细胞的浸润;非AF组可见中度中性粒细胞的浸润和炎症反应;而AF组食管黏膜组织出现不同程度的中性粒细胞,嗜酸性粒细胞等免疫细胞的浸润、乳头延长、水肿等炎症性改变。AF组炎症评分达到高峰,并显著高于非AF组(P<0.01)。免疫组化结果发现,对照组8-OHdG主要表达在食管上皮层、黏膜及黏膜下层,而AF组8-OHdG的表达几乎覆盖全层黏膜,表示严重的组织氧化损伤。RT-PCR和ELISA实验发现,与对照组相比,8-OHdG、MCP-1、IL-8、TNF-α的mRNA相对表达量以及其血清浓度,在非AF组和AF组中明显上升,且AF组中达到高峰,三组之间差异具有统计学意义(P<0.01)。Pearson相关性分析得出,AF组中8-OHdG血清浓度分别与Demeester评分及MCP-1、IL-8、TNF-α血清浓度之间具有正相关关系(P<0.01)。结论 8-OHdG以及炎症因子(MCP-1、IL-8、TNF-α)在GERD合并AF患者食管黏膜的表达及血清浓度显著增高,可能与酸反流诱发AF的产生密切相关。
