中老年非外伤性食管裂孔疝二维及三维超声诊断研究

目的探讨经腹部二维及三维超声在中老年非外伤性食管裂孔疝（HH）诊断中的临床价值。方法采用饮水胃充盈法对32例中老年患者行半坐位、立位、仰卧位等多体位二维及三维超声检查并与X线钡餐造影、内镜检查和手术检查结果对照分析。结果32例中老年HH患者经腹部二维及三维超声表现：（1）膈肌食管裂孔增宽（前后径0.9-2.5,平均1.6±0.4 cm）及膈上疝囊,膈上疝囊中见胃黏膜回声10例;超声诊断滑动性HH 27例,食管旁型HH 3例,短食管型HH 2例。同期检查的正常中老年食管裂孔无增宽（前后径0.7-1.5,平均1.0±0.2 cm）,无膈上疝囊。（2）实时三维超声沿膈肌食管裂孔长轴观显示32例HH膈上囊腔呈“蘑菇状”或“池塘样”,疝囊颈部呈不规则“坑道样”或“沟壑样”;从胃底面向上观察可见膈上裂孔呈“洞穴样”或“天窗样”;从纵隔面向下观察可见膈上裂孔呈“凿孔状”。超声诊断与X线钡餐造影（32例）、内镜（13例）和手术检查（4例）结果均符合。结论经腹部二维超声可准确诊断中老年人非外伤性HH;实时三维超声可清晰显示疝口的范围、大小、形态,二维及三维超声联合应用可为临床诊断中老年人非外伤性HH提供更全面的诊断信息。     

新生儿期膈疝的超声表现及诊断价值

目的探讨新生儿期膈疝的超声声像图特点。 方法选择2000年1月至2017年12月首都医科大学附属北京儿童医院超声及手术病理检查确诊为新生儿期膈疝的患儿19例,平均出生（12.8±11.7）d,其中3例产前已诊断膈疝,11例表现为呼吸困难,3例表现为呕吐,2例表现为心动过速。总结19例新生儿超声声像图特点。 结果19例新生儿膈疝术前超声显示自左侧胸腔内疝入小肠4例,胃底2例,脾脏3例,1例疝入物为左侧肾上腺及左肾上极;右侧胸腔内疝入肠管3例,4例疝入物为部分肝脏右叶及胆囊,2例疝入物为右肾上腺及右肾。食道裂孔疝疝入物均为胃。后外侧疝表现为膈肌不连续,位于腹腔内或腹膜后的脏器通过不连续的膈肌进入胸腔水平。食道裂孔疝表现为胃体通过食管裂孔疝入胸腔。术前超声诊断后外侧疝16例,食道裂孔疝2例,1例膈疝与膈膨升不能鉴别。与术前相关影像及手术检查结果对照,术前超声诊断符合率为94.74%（18/19）。 结论新生儿期患儿胸壁软组织薄,超声检查可清晰实时多角度显示膈肌情况,诊断符合率不低于CT或磁共振成像,且无放射性损伤,是新生儿期膈疝患儿首选的影像学检查方法。     

胃超声造影诊断食管裂孔疝的价值

目的总结食管裂孔疝(EHH)患者超声造影表现,探讨超声造影对EHH的诊断价值.方法 回顾性分析88例EHH患者的超声造影表现,并与50名健康人进行比较.结果 50名健康人贲门及腹段食管结构均清晰,食管裂孔直径为(1.96±0.39)cm,EHH患者膈下均不能探及腹段食管及贲门结构,食管裂孔直径为(3.24±0.76)cm,较健康人增宽,且差异有统计学意义(t=2.36,P＜0.05).78例EHH患者平静状态下膈可见疝囊,10例加压后出现膈上疝囊,疝囊直径最大7.6 cm,疝囊大小可随腹压变化,滑动性EHH患者可见囊壁于膈肌上下滑动,2例EHH患者可见囊壁占位.76例EHH患者可见B环.健康人平卧位左肋缘下斜切面超声造影示胃底横隔均处于下垂或水平状态,73例EHH患者可见胃底横隔上翘.结论 EHH患者超声造影表现有特点.超声造影易发现及诊断EHH,对疝囊占位亦有一定的诊断价值.超声造影可作为EHH的一种筛查手段.     

食管裂孔疝的多层螺旋CT诊断

目的评价食管裂孔疝的多层螺旋CT(MSCT)诊断价值。方法回顾性分析20例经手术或消化道钡餐证实的食管裂孔疝患者的MSCT资料,18例行MSCT平扫,2例行平扫加增强扫描。结果滑动性食管裂孔疝14例,短食管型裂孔疝4例,食管旁型裂孔疝2例。CT表现为膈上疝囊20例,纵隔脂肪增多11例,膈脚分离移位20例,"8"字征15例;2例增强扫描疝囊囊壁强化与膈下胃壁强化一致。结论各型食管裂孔疝MSCT表现有一定的特点,MSCT在其诊断中具有较高的价值。     

膈疝的X线特征及分析

目的分析膈疝的X线特征,并对其检查方法进行比较。方法本组22例包括可复性食管裂孔疝3例,不可复性食管裂孔疝7例,胸腹膜裂孔疝5例,胸骨旁裂孔疝1例,创伤性膈疝6例。全部摄胸片,14例作钡餐,1例作钡灌肠,8例作胸部CT。结果14例膈疝钡餐清晰显示胃、小肠、或结肠疝入胸腔内,1例膈疝钡灌肠清晰显示结肠脾曲疝入胸腔内,7例膈疝CT显示部分大网膜、胃、小肠、结肠或部分脾组织疝入胸腔内。结论当膈疝内容物为消化道空腔脏器时,运用钡餐或钡灌肠诊断膈疝为最佳选择,创伤性膈疝应配以CT检查诊断效果更佳。     

食管裂孔疝超声声像图分析

目的:探讨胃肠超声造影诊断食管裂孔疝(EHH)的超声声像图特点,以提高对该病的认识。材料与方法:回顾分析经胃镜及X线钡餐造影证实的23例EHH超声声像图表现。结果:23例EHH患者,胃肠超声造影确诊21例,误诊1例,漏诊1例;其中滑动性EHH19例,食管旁疝1例,混合型EHH1例。23例EHH患者出现膈上疝囊21例(91.3%),且疝囊内粘膜皱襞与胃内粘膜皱襞相连续;B环上移19例(82.6%);食管裂孔扩大19例(82.6%);食管胃角(His角)变钝16例(69.6%);胃底横膈异常17例(73.9%);胃食管返流21例(91.3%)。结论:EHH具有典型声像图特点,胃肠超声造影可作为EHH的初步筛查手段。     

膈疝的影像诊断价值

目的:分析隔疝的胸部平片、胃肠道钡餐造影及胸部螺旋CT表现,探讨其诊断价值。材料与方法:对62例有完整的临床、影像、手术病理资料的膈疝进行回顾性分析。62例中食管裂孔疝26例,胸腹膜裂孔疝14例,胸骨旁裂孔疝5例,创伤性膈疝17例。结果:平片检查快速、简便、价格低廉,但诊断价值有限,正确率仅45.2%;钡餐造影明显优于平片,正确率77.4%,但对实质性脏器显示能力差,易致误诊;螺旋CT检查明显优于平片和胃肠钡剂造影,正确率95.5%,加用三维重建可清楚显示疝内容物及膈肌缺损部位及范围,但对滑动性疝易漏诊且不能反映胃肠道功能。结论:三种影像检查方法各有其特点,螺旋CT是最有价值检查方法,三者有机结合,可提高诊断正确率。     

超声与MRI在先天性膈疝产前诊断中的应用价值

目的探讨超声与MRI在先天性膈疝产前诊断的应用价值。方法选取我院经引产或出生后检查证实的先天性膈疝70例,经胸腹部多切面和系统超声检查观察是否合并其他异常。并与MRI胸腹部冠状面、矢状面及横断面扫描结果进行对照分析。结果胎儿左侧膈疝58例,右侧膈疝12例,单发性膈疝51例,合并羊水过多9例,合并其他结构异常19例,合并心脏发育异常7例;经产前超声诊断69例,诊断符合率为98.57%;漏诊1例,后经MRI证实。结论超声能够较准确地诊断先天性膈疝,是常规产科筛查的首选,MRI有利于进一步明确诊断。     

小儿先天性膈疝的X线诊断——附98例分析

笔者报道了经手术证实的先天性膈疝98例，其中胸腹裂孔疝51例，食管裂孔疝43例，胸骨后疝4例，其中大部分年龄为6岁以下。本文着重分析了各类X线表现的共同点与特点，根据作者经验胸平片必须正与侧位片，确诊用食道胃肠钡餐检查。鉴别诊断困难时可选用CT，B超或同位素扫描检查。     

老年性食管裂孔疝的常规X线检查及诊断(附31例报告)

目的 探讨和分析老年性食管裂孔疝的X线检查方法及影像学特征.方法 回顾性分析31例均经消化道钡餐检查确诊为老年性食管裂孔疝的胸透、胸片及钡餐检查的影像学表现.结果 胸透及胸片检查23例,其中胸透体检9例,胸片检查14例,均表现为心后区囊性团块状阴影,20例随即进行钡餐检查诊断为不可复性食管裂孔疝,其中胸片检查3例,2例误诊为左下肺占位病变,1例误认为降主动脉瘤.胃肠钡餐检查8例,均发现胃黏膜进入膈上胸腔内,其中5例诊断为不可复性食管裂孔疝,3例为可复性.结论 三种常规X线检查作用不一,简单经济,其中胸透、胸片检查较容易发现病灶,消化道钡餐检查的X线表现具有特征性,对老年性食管裂孔疝的诊断最具意义.     

内镜检查中反流性食管炎及相关因素的调查分析

目的探讨内镜检查中反流性食管炎及其相关因素如食管裂孔疝的发病情况及临床特点。方法回顾我院1999年1月-2000年12月胃镜检查资料，检出符合标准的反流性食管炎、食管裂孔疝及其它与食管炎相关的病例，分析各种病例检出情况、临床特点及合并症。结果反流性食管炎167例，检出率3．85％；食管裂孔疝101例，检出率2、47％；其中反流性食管炎合并食管裂孔疝66例(39．52％)，而食管裂孔疝中61．68％合并反流性食管炎；反流性食管炎合并十二指肠溃疡并不全梗阻37例(22．16％)，胆汁反流7例(4．19％)，急性胃黏膜病变4例(2．39％)，残胃6例(3．59％)。另外，反流性食管炎中有20例(11．97％)患者表现为贲门松弛。食管炎合并食管裂孔疝的患者较单纯食管裂孔疝的患者年龄明显增大，前者58、88岁，后者40．03岁。合并食管炎的食管裂孔疝患者反酸、烧心症状的发生率较单纯裂孔疝高。结论反流性食管炎与很多因素有关，食管裂孔疝为反流性食管炎的重要病因，随着年龄增大食管裂孔疝合并反流性食管炎的机率增加、尤其是老年人伴有反流症状的更要引起注意。     

食管裂孔疝数字胃肠影像与胃镜检查结果对比分析

目的:分析数字胃肠机与胃镜在食管裂孔疝诊断中的价值。材料与方法:采用数字胃肠机与胃镜分别对43例食管裂孔疝进行检查,并对两种结果进行并对分析。结果:43例X线可见食管粘膜增粗、毛糙,少数患者食管下段出现多发性毛刺状浅龛影,食管下段多见痉挛,食管排空功能减低,钡剂滞留,疝囊形成。B环形成,贲门切迹改变。胃镜检查食管腔内可见胃底粘膜,贲门切迹改变,有时可见疝囊。粘膜充血水肿,齿状线不清晰或增厚发白,贲门口扩大。结论:数字胃肠机检查对食管及其病变整体表现占优势。可获得腔内形态结构及其细节更多信息。结合食管运动功能进行研究,使诊断更加客观全面和准确。     

Predictive relationship of hiatal hernia to reflux esophagitis

The relationship between hiatal hernia and reflux esophagitis was compared in 93 patients who underwent both radiographic and endoscopic examination of the esophagus. In 46 patients with a normal esophagus shown endoscopically, hiatal hernia was present in 59%, while 94% of 47 patients with reflux esophagitis had hiatal hernia. The positive and negative predictive values for hiatal hernia in diagnosing or excluding esophagitis were 62% and 86%, respectively. Extrapolation of these data and review of the literature suggest that much of the confusion concerning the relationship between hiatal hernia and reflux esophagitis is based on reports of populations with considerable variation in the prevalence of esophagitis and in which the radiographie criteria for diagnosing hiatal hernia have not been uniformly applied.     

Totally laparoscopic gastrectomy for early gastric cancer accompanied by huge hiatal hernia: A case report

We herein present a case in which we used a totally laparoscopic approach for early gastric cancer accompanied by a huge hiatal hernia. An 80‐year‐old Japanese woman was referred with a chief complaint of dysphagia. A clinical diagnosis of early gastric cancer, T1b (SM) N0M0, stage IA, accompanied by hiatal hernia, was made. Distal gastrectomy with D1 plus lymphadenectomy was carried out. After the gastrectomy, the hernial sac was excised and the hernial orifice was closed. Reconstruction using the Roux‐en‐Y method was selected. The postoperative course was uneventful and she was discharged on postoperative day 10.     

Laparoscopic repair of paraesophageal hernia with organo‐axial intrathoracic gastric volvulus

Intrathoracic organo‐axial gastric volvulus is a rare clinical entity associated with paraesophageal hernia. It is characterized by migration of the stomach into the thoracic cavity through an enlarged hiatal defect and rotation around its long axis connecting the cardia and the pylorus. A 72‐year‐old woman presented with epigastric pain that radiated to the left scapula for 1 week prior to presentation. Computed tomography scan of her thorax and abdomen demonstrated paraoesophageal hernia with organo‐axial intrathoracic gastric volvulus. Laparoscopically, the stomach was returned to its abdominal position, the mediastinal sac was excised and after adequate intra‐abdominal length of the esophagus was attained, the hiatal defect was closed primarily and reinforced with a composite mesh. An anterior 180° partial fundoplication was performed as both an anti‐reflux procedure and also as a form of gastropexy. She had an uneventful recovery and remains well after 2 years.     

Cervical Disk Lesions

Generally the initial treatment for symptomatic, uncomplicated hiatal hernia should be a trial of medical therapy. An ulcer-type regimen is instituted to inhibit reflux of gastric juice into the esophagus and reduce gastric hyperacidity. Other objectives are reduction of intra-abdominal pressure and control of aerophagy. Esophagoscopy is an important part of management. Coexisting chronic peptic ulcer of the esophagus, stomach or duodenum or gastric hyperacidity may tip the scales in favor of surgical repair of the hernia.     

Long-term clinical outcome of elderly patients with reflux esophagitis: a six-month to three-year follow-up study

Although the prevalence of reflux esophagitis is known to increase with age, data on the long-term outcome of esophagitis in elderly patients are scarce. We sought to evaluate the clinical outcome of elderly patients with esophagitis 6 months to 3 years after diagnosis and to identify specific prognostic indicators of a poor outcome. This was a long-term (6 months to 3 years) follow-up study. Patients older than 65 years of age diagnosed as having reflux esophagitis healed after acute treatment (2 to 4 months) were included in the study. Clinical examinations and upper gastrointestinal endoscopy were performed every 6 months for the first year and annually thereafter. After healing, no therapy was prescribed; in the event of symptom recurrence, a maintenance therapy consisting either of H2 blockers or proton pump inhibitors (PPI) was prescribed. At baseline and during follow-up, the following clinical parameters were recorded: gender, age, the presence of symptoms (heartburn, acid regurgitation, epigastric/chest pain), type and dose of the maintenance therapy, nonsteroidal antiinflammatory drug use; gastric Helicobacter pylori infection, diagnosis of hiatal hernia, and/or Barrett's esophagus. The chi-square test, the Kaplan-Meier test, and Cox's proportional hazards regression analysis were used for statistical analyses. Included in the final analysis were 138 patients (M/F, 81/57; mean age, 79.7 years; range, 66-97). The numbers of patients in need of maintenance therapy were 47 of 69 (68.1%) after 6 months, 29 of 58 (50%) after 12 months, 17 of 39 (43.6%) after 24 months, and 12 of 26 (46.1%) after 36 months of follow-up. A significantly higher esophagitis relapse rate was found in patients not treated compared with subjects who were in maintenance therapy: 59% versus 8.5% (P <.0001) at 6 months, 65.5% versus 20.7% at 12 months (P <.002), 63.6% versus 11.7% at 24 months (P =.003), and 57.1% versus 8.3% at 36 months (P =.02). No significant difference in relapse rate was found in patients treated with H2 blockers versus PPIs (21.7% versus 10%). The Cox model demonstrated that no maintenance treatment (P =.00001), the presence of typical symptoms (P =.00001), the presence of hiatal hernia (P =.03), and a high severity grade of esophagitis at baseline (P =.009) were risk factors for relapse of esophagitis. In elderly subjects, esophagitis relapse occurs in a high percentage of cases, particularly in patients not treated with antisecretory drugs. The presence of typical symptoms, hiatal hernia, and a severe grade of esophagitis are risk factors for relapse. The most effective measure for minimizing the occurrence of relapse is a maintenance therapy with antisecretory drugs.