食管胃底静脉曲张合并腹外疝内镜下治疗分析

目的 探讨食管胃底静脉曲张合并腹外疝患者内镜下治疗的临床特点以及疝修补术手术时机的选择。方法 回顾2000 -2013 年我院收治的11 例食管胃底静脉曲张合并腹外疝患者，其入院时疝的部位、类型、诊断时间，以及行内镜下食管胃底静脉曲张治疗术中、术后疝的临床特点。结果 11 例均为腹股沟斜疝，左侧3 例，右侧7 例，双侧1 例。可复性疝10 例，难复性疝1 例且合并脐疝、右侧睾丸鞘膜积液。除1 例为已行疝修补术后复发，余10 例均无手术史。患者行胃镜检查平均1.6次，内镜下治疗平均3.6 次。内镜诊治过程中采用助手压迫疝环或腹带包扎固定方式防止疝复发。术中无发生嵌顿者，术后发生3 人次，平均为术后（10±8.29） d 发生，均采用手法还纳成功。结论 合并腹外疝的食管胃底静脉曲张内镜下治疗因操作疗程多且术中过多注气等因素，增加了发生嵌顿疝的风险，内镜治疗前应评估是否可先行疝修补手术。

Endoscopic treatment of esophagogastric varices accompanying abdominal external hernia

Objective To study the endoscopic treatment of esophagogastric varices and the surgical time of abdominal external hernia. Methods Location, type, diagnosis and clinical features of abdominal external hernia in 11 patients with esophagogastric varices accompanying abdominal external hernia admitted to our hospital from 2000 to 2013 were retrospectively analyzed. Results Of the 11 patients with indirect inguinal hernia, 3 were diagnosed with left-indirect hernia, 7 with right-indirect hernia, 1 with bilateral indirect hernia, 10 with reducible hernia, and 1 with irreducible hernia accompanying umbilical hernia and hydrocele of right testis. The patients had no history of operation except 1 who had relapse after repair of hernia. The patients underwent 1.6 times of gastroscopy and 3.6 times of endoscopic treatment, during which the hernias ring was compressed or bandaged with bellyband to prevent relapse of hernia. No incarcerated hernia occurred during operation and incarcerated hernia occurred in 3 patients after operation. The incarcerated hernias were returned to enterocoelia manually. Conclusion The risk to develop incarcerated hernia increases due to multiple endoscopic treatment procedures of esophagogastric varices accompanying abdominal external hernia and gas injection. Repair of hernia should be considered before endoscopic treatment.