-
摘要: 食管裂孔疝多见于中老年人,女性多于男性,主要原因是膈肌裂孔周围韧带结构弹性降低或慢性疾病使胃内压力长期升高所致。长期的酸暴露会使食管痉挛、缩短,导致食管轴向压力增加进而诱发食管裂孔疝。其中滑动型食管裂孔疝最常见,而混合型食管裂孔疝最少见。本文报道1例混合型食管裂孔疝伴胃扭转病例,患者胃食管结合部、胃底、贲门、部分胃体均已疝入胸腔。由于疝入的内容物较多,出现胃扭转和肺不张,行腹腔镜下食管裂孔疝修补术、膈疝修补术、胃底折叠术、网膜粘连松解术,手术顺利,患者术后恢复可。Abstract: Hiatal hernia mainly occurs in the elderly, and the female is more than the male, it is mainly due to the decrease of the structural elasticity of the ligament around the diaphragmatic hiatus or the long-term increase of gastric pressure caused by chronic diseases. And long-term acid exposure will make the esophagus spasm, shorten, resulting in increased esophageal axial pressure and then induce esophageal hiatal hernia. One of the most common types of hiatal hernia is sliding hiatal hernia, mixed hiatal hernia is the most rarely seen. The paper reports a patient with mixed hiatal hernia and gastric torsion, the patient is characterized by gastroesophageal junction、stomach bottom、cardia、a portion of gastric body sliding into thoracic cavity. The mixed hiatal hernia also leads to gastric torsion and lung atrophy, Laparoscopic esophageal hiatal hernia repair, diaphragmatic hernia repair, fundofolding, and omental adhesion release were performed. The operation was smooth, and the patient recovered after surgery.
-
Key words:
- hiatal hernia /
- hiatal hernia repair /
- gastric torsion /
- gastroscope
-
[1] 张海静, 胡海清. 食管裂孔疝诊治进展[J]. 中华胃肠内镜电子杂志, 2020, 7(1): 33-38. doi: 10.3877/cma.j.issn.2095-7157.2020.01.009
[2] Kishikawa H, Kimura K, Ito A, et al. Correction: association between increased gastric juice acidity and sliding hiatal hernia development in humans[J]. PLoS One, 2017, 12(2): e0172375. doi: 10.1371/journal.pone.0172375
[3] 何岚, 郑松柏. 老年食管裂孔疝的诊治进展[J]. 老年医学与保健, 2021, 27(6): 1332-1335. https://www.cnki.com.cn/Article/CJFDTOTAL-LYBJ202106051.htm
[4] 阿卜来提·艾则孜, 阿地力·阿布拉. 腹腔镜食管裂孔疝修补术25例疗效分析[J]. 中华胃食管反流病电子杂志, 2021, 8(2): 85-88.
[5] 元海成, 张楠, 董国强, 等. 巨大食管裂孔疝诊断和腹腔镜治疗研究进展[J]. 中国中西医结合外科杂志, 2021, 27(6): 923-927. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202106032.htm
[6] 艾合买提江·库尔班, 布娅·米然别克, 高峰. 无痛胃镜与普通胃镜下诊断食管裂孔疝的特征分析[J]. 中华胃食管反流病电子杂志, 2017, 4(1): 16-18. https://www.cnki.com.cn/Article/CJFDTOTAL-SDFL201701004.htm
[7] 任伟霞, 杨秀清, 刘荫荣, 等. 重度食管裂孔疝患者CT和胃镜表现及内外科治疗效果分析[J]. 医学影像学杂志, 2021, 31(7): 1196-1199.
[8] 周太成, 江志鹏, 李英儒, 等. 食管裂孔疝及胃食管反流性疾病腹腔镜下规范化七步法手术操作指南(2021版)[J]. 岭南现代临床外科, 2021, 21(5): 500-506.
[9] 孙明明, 韩富华, 胡根, 等. 腹腔镜疝修补联合胃底折叠治疗胃食管反流病25例临床分析[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(2): 128-130.
[10] 杨作磊. 胃食管反流病合并食管裂孔疝的内镜及腹腔镜治疗进展[J]. 现代医药卫生, 2020, 36(18): 2944-2948.
[11] Yang XF, Hua R, He K, et al. Laparoscopic hernioplasty of hiatal hernia[J]. Ann Transl Med, 2016, 4(18): 343.
[12] 陈瑶, 杨锦林, 王一平. 胃食管反流病合并食管裂孔疝的诊治[J]. 中华消化内镜杂志, 2019, 36(3): 224-228.
[13] 李娜, 侯颖, 董长城. 腹腔镜疝修补术结合Nissen胃底折叠术治疗胃食管反流合并食管裂孔疝的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(1): 36-39. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFD202201008.htm
[14] 罗冰清, 张秋子, 张也, 等. 腹腔镜食管裂孔疝修补术联合改良DOR胃底折叠术治疗食管裂孔疝合并胃食管反流病的临床疗效[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(1): 40-43. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSFD202201009.htm
[15] 边铁军, 龙志强, 王雷勇. 胸腔镜辅助MarkⅣ手术治疗食管裂孔疝36例临床报告[J]. 现代养生(下半月版), 2022, 22(2): 311-313.
[16] 吕剑, 杨玉清, 丁凯, 等. 巨大混合型食管裂孔疝一例[J]. 中国全科医学, 2013, 16(24): 2906-2907. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201330047.htm